Healthcare Provider Details

I. General information

NPI: 1760531206
Provider Name (Legal Business Name): HOMETOWN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 ALLGOOD ST
TRION GA
30753-1341
US

IV. Provider business mailing address

194 ALLGOOD ST
TRION GA
30753-1341
US

V. Phone/Fax

Practice location:
  • Phone: 706-734-2878
  • Fax: 706-734-2877
Mailing address:
  • Phone: 706-734-2878
  • Fax: 706-734-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARLENE MCRAE
Title or Position: OFFICE MANGER
Credential:
Phone: 706-734-2878