Healthcare Provider Details

I. General information

NPI: 1972881423
Provider Name (Legal Business Name): CALHOUN MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TIMMS RD NE
CALHOUN GA
30701-7016
US

IV. Provider business mailing address

400 TIMMS RD NE
CALHOUN GA
30701-7016
US

V. Phone/Fax

Practice location:
  • Phone: 706-625-0022
  • Fax: 706-625-3988
Mailing address:
  • Phone: 706-625-0022
  • Fax: 706-625-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HARVEY P LEBLANC JR.
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 706-625-0333