Organization
CROWN HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIUS BADE ODERINDE MD (CEO)
(478) 714-6901
Entity
Organization
Contact information
Practice address
155 WESTRIDGE PKWY, SUITE 106, MCDONOUGH, GA 30253-3049
(404) 289-2500
(404) 748-4520
Mailing address
155 WESTRIDGE PKWY, SUITE 106, MCDONOUGH, GA 30253-3049
(404) 289-2500
(404) 748-4520
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
036658
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356437040
NPI
GA
Enumeration date
05/25/2010
Last updated
01/13/2011
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