Provider Demographics
NPI:1386970374
Name:CFS HEALTH MANAGEMENT
Entity type:Organization
Organization Name:CFS HEALTH MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALID
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-423-9449
Mailing Address - Street 1:413 POTTERY FACTORY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-6682
Mailing Address - Country:US
Mailing Address - Phone:706-423-9449
Mailing Address - Fax:706-423-9443
Practice Address - Street 1:413 POTTERY FACTORY DR
Practice Address - Street 2:SUITE A
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-6682
Practice Address - Country:US
Practice Address - Phone:706-423-9449
Practice Address - Fax:706-423-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026067174400000X
GA062097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA738465785AMedicaid
GA202G706030Medicare PIN