Healthcare Provider Details

I. General information

NPI: 1659206407
Provider Name (Legal Business Name): NORTHEAST GEORGIA PHYSICIANS GROUP URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 BIG A RD
TOCCOA GA
30577-6002
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-3148
  • Fax:
Mailing address:
  • Phone: 706-886-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA HERNANDEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 308-765-0369