Healthcare Provider Details

I. General information

NPI: 1235865478
Provider Name (Legal Business Name): GREGORY JOHN PLAGEMANN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

737 SYCAMORE DR
VILLA RICA GA
30180-5323
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-4000
  • Fax:
Mailing address:
  • Phone: 678-516-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN226581
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: