Coraccess, Inc

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

003373 Issued in GA

Legal business name

CORACCESS, INC

Practice address

1478 Leafview Rd
Decatur, GA 30033-2112

Phone

(678) 462-9734

NPI assigned

Jun 26, 2012

Last updated

May 13, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles David Foreman, PA-C

Title

Physician Assistant

Phone

(678) 462-9734

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368403200000",
    "number": "1558625319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1478 LEAFVIEW RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300332112",
            "telephone_number": "678-462-9734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1478 LEAFVIEW RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300332112",
            "telephone_number": "678-462-9734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORACCESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-26",
        "last_updated": "2013-05-13",
        "status": "A",
        "authorized_official_last_name": "FOREMAN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "678-462-9734",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "003373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "363A00000X",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Decatur, GA
• Providers in Decatur, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.