Healthcare Provider Details

I. General information

NPI: 1902407307
Provider Name (Legal Business Name): ENDOCRINE SPECIALISTS OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FOX CHASE
CARTERSVILLE GA
30120-2491
US

IV. Provider business mailing address

PO BOX 2016
CARTERSVILLE GA
30120-1684
US

V. Phone/Fax

Practice location:
  • Phone: 770-382-0185
  • Fax: 770-382-0247
Mailing address:
  • Phone: 770-382-0185
  • Fax: 770-382-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCISCO PUENTES
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 770-382-0185