Healthcare Provider Details

I. General information

NPI: 1649536749
Provider Name (Legal Business Name): NG MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 BROWNS BRIDGE RD STE 1
CUMMING GA
30041-4554
US

IV. Provider business mailing address

4355 BROWNS BRIDGE RD STE 1
CUMMING GA
30041-4554
US

V. Phone/Fax

Practice location:
  • Phone: 770-771-5050
  • Fax: 770-771-5051
Mailing address:
  • Phone: 770-771-5050
  • Fax: 770-771-5051

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
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDEE NICOLE URRUTIA
Title or Position: PRESIDENT / OWNER
Credential: M.D.
Phone: 770-771-5050