Healthcare Provider Details

I. General information

NPI: 1588648745
Provider Name (Legal Business Name): AMGP GEORGIA MANAGED CARE COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PERIMETER CTR N SUITE 400
ATLANTA GA
30346-2402
US

IV. Provider business mailing address

303 PERIMETER CTR N SUITE 400
ATLANTA GA
30346-2402
US

V. Phone/Fax

Practice location:
  • Phone: 678-587-4840
  • Fax: 770-604-9330
Mailing address:
  • Phone: 678-587-4840
  • Fax: 770-604-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2004124
License Number StateGA

VIII. Authorized Official

Name: STEVEN EUGENE MEEKER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 678-587-4840