Organization
CC METABOLICS OF GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY WAGGONER (CREDENTIALING MANAGER)
(214) 202-1023
Entity
Organization
Contact information
Practice address
931 E WINTHROPE AVE, MILLEN, GA 30442-1839
(478) 239-0230
(478) 210-1107
Mailing address
6 PINE VALLEY RD SW, ROME, GA 30165-4338
(904) 860-9180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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