Healthcare Provider Details

I. General information

NPI: 1982567327
Provider Name (Legal Business Name): GRUPO MEDICO DE GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 S LEE ST STE B
BUFORD GA
30518-3872
US

IV. Provider business mailing address

4225 S LEE ST STE B
BUFORD GA
30518-3872
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-3555
  • Fax: 678-730-7777
Mailing address:
  • Phone: 770-559-3555
  • Fax: 678-730-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDDY LAJARA
Title or Position: MANAGER
Credential:
Phone: 770-559-3555