Organization
COVID COMMUNITY TESTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE W WALRAVEN MD (MD)
(678) 364-8414
Entity
Organization
Contact information
Practice address
1000 COMMERCE DR STE 400, PEACHTREE CITY, GA 30269-3520
(678) 364-8404
(678) 545-0146
Mailing address
1000 COMMERCE DR STE 400, PEACHTREE CITY, GA 30269-3520
(678) 364-8404
(678) 545-0146
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4026
MEDICARE - GA
GA
Enumeration date
07/28/2020
Last updated
02/19/2021
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