Healthcare Provider Details

I. General information

NPI: 1790721942
Provider Name (Legal Business Name): NORTHEAST GEORGIA MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 WHITE SULPHUR RD SUITE 285
GAINESVILLE GA
30501-8921
US

IV. Provider business mailing address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-8899
  • Fax: 770-219-8898
Mailing address:
  • Phone: 770-219-9000
  • Fax: 770-219-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

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