Healthcare Provider Details

I. General information

NPI: 1558314112
Provider Name (Legal Business Name): GEORGIA INPATIENT MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901-C PEACHTREE DUNWOODY ROAD SUITE 350
ATLANTA GA
30328-7159
US

IV. Provider business mailing address

PO BOX 96368
OKLAHOMA CITY OK
73143-6368
US

V. Phone/Fax

Practice location:
  • Phone: 678-441-8500
  • Fax: 678-397-0065
Mailing address:
  • Phone: 800-962-3303
  • Fax: 405-682-1586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TALBOT G MCCORMICK III
Title or Position: PRESIDENT
Credential: MD
Phone: 678-441-8500