Provider Demographics
NPI:1972743813
Name:1STCARE, LLC
Entity type:Organization
Organization Name:1STCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-692-5910
Mailing Address - Street 1:1365 ROCK QUARRY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5029
Mailing Address - Country:US
Mailing Address - Phone:770-692-5910
Mailing Address - Fax:770-692-5916
Practice Address - Street 1:1365 ROCK QUARRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5029
Practice Address - Country:US
Practice Address - Phone:770-692-5910
Practice Address - Fax:770-692-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty