Provider Demographics
NPI:1730371717
Name:ALL CARE MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:ALL CARE MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-225-9001
Mailing Address - Street 1:2929 WATSON BLVD
Mailing Address - Street 2:STE 2 BOX 332
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8535
Mailing Address - Country:US
Mailing Address - Phone:478-225-9001
Mailing Address - Fax:478-225-9167
Practice Address - Street 1:1860 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3612
Practice Address - Country:US
Practice Address - Phone:478-225-9001
Practice Address - Fax:478-225-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA138340105EMedicaid
GAH34245Medicare UPIN
GA138340105EMedicaid
GA511I110058Medicare PIN