Provider Demographics
NPI:1124309893
Name:CIRCADIA MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:CIRCADIA MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-377-6539
Mailing Address - Street 1:P O BOX 4048
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4048
Mailing Address - Country:US
Mailing Address - Phone:770-457-7812
Mailing Address - Fax:770-457-7649
Practice Address - Street 1:4360 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:STE 515
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1049
Practice Address - Country:US
Practice Address - Phone:770-457-7812
Practice Address - Fax:770-457-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty