Provider Demographics
NPI:1063172625
Name:CENTENNIAL JOINT CARE INC
Entity type:Organization
Organization Name:CENTENNIAL JOINT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-248-8456
Mailing Address - Street 1:1171 LAUREL POINTE
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7559
Mailing Address - Country:US
Mailing Address - Phone:706-248-8456
Mailing Address - Fax:
Practice Address - Street 1:1235 FRIENDSHIP RD STE 115
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5624
Practice Address - Country:US
Practice Address - Phone:770-904-9014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty