Provider Demographics
NPI:1902292352
Name:CENTRAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL HEALTH ASSOCIATES
Other - Org Name:CENTRAL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FAWZI
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MEHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-648-5300
Mailing Address - Street 1:P.O. BOX 6896
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33807
Mailing Address - Country:US
Mailing Address - Phone:863-648-5300
Mailing Address - Fax:863-648-5377
Practice Address - Street 1:4925 OLD RD 37
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-648-5300
Practice Address - Fax:863-648-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256420300Medicaid