Provider Demographics
NPI:1144273608
Name:CREATIVE CARE CONCEPTS, INC.
Entity type:Organization
Organization Name:CREATIVE CARE CONCEPTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-478-6091
Mailing Address - Street 1:1943 SAYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2681
Mailing Address - Country:US
Mailing Address - Phone:770-478-6091
Mailing Address - Fax:770-478-6875
Practice Address - Street 1:1943 SAYBROOK CT
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2681
Practice Address - Country:US
Practice Address - Phone:770-478-6091
Practice Address - Fax:770-478-6875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2865Medicare ID - Type Unspecified