Healthcare Provider Details

I. General information

NPI: 1457388571
Provider Name (Legal Business Name): NORTHEAST GEORGIA MEDICAL CENTER., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LIMESTONE PKWY SUITE 222
GAINESVILLE GA
30501-2567
US

IV. Provider business mailing address

2150 LIMESTONE PKWY SUITE 222
GAINESVILLE GA
30501-2567
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-8888
  • Fax: 770-219-6694
Mailing address:
  • Phone: 770-219-8888
  • Fax: 770-219-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: BRIAN D STEINES
Title or Position: CFO
Credential:
Phone: 770-219-3562