Provider Demographics
NPI:1386930907
Name:COWETA OCCUPATIONAL MEDICINE
Entity type:Organization
Organization Name:COWETA OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARVELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-502-2121
Mailing Address - Street 1:1825 HIGHWAY 34 E
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6423
Mailing Address - Country:US
Mailing Address - Phone:770-502-2121
Mailing Address - Fax:770-502-2113
Practice Address - Street 1:1825 HIGHWAY 34 E
Practice Address - Street 2:SUITE 1300
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6423
Practice Address - Country:US
Practice Address - Phone:770-502-2121
Practice Address - Fax:770-502-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine