Healthcare Provider Details

I. General information

NPI: 1427484963
Provider Name (Legal Business Name): PHYSICIAN MANAGEMENT & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SHILOH RD NW SUITE 311
KENNESAW GA
30144-7194
US

IV. Provider business mailing address

1050 SHILOH RD NW SUITE 311
KENNESAW GA
30144-7194
US

V. Phone/Fax

Practice location:
  • Phone: 404-433-0044
  • Fax:
Mailing address:
  • Phone: 404-433-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: WES EBY
Title or Position: MANAGING OFFICER
Credential:
Phone: 404-433-0044