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NPI Code Detail

MEDICARE: HARGRAVE EMERGENCY PHYSICIANS LLC

MEDICARE: HARGRAVE EMERGENCY PHYSICIANS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1760744668
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARGRAVE EMERGENCY PHYSICIANS LLC
Provider Business Mailing Address
First Line : 13737 NOEL RD
Second Line : STE 1600
City : DALLAS
State : TX
Zip : 75240-1331
Country : US
Telephone Number : 469-401-2386
Fax Number :
Provider Business Practice Location Address
First Line : 100 GROSS CRESCENT CIR
Second Line :
City : FT OGLETHORPE
State : GA
Zip : 30742-3643
Country : US
Telephone Number : 706-585-2000
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. GREGORY J. BYRNE
Credential : MD
Telephone Number : 469-401-2386
Provider Enumeration Date : 06/15/2012
Last Update Date : 12/24/2013

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