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General NPI Number Information
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NPI Number | 1073753299
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Entity Type | Organization
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Legal Business Name | MONROE HMA PHYSICIAN MANAGEMENT LLC
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 3543 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 770-913-8082
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Fax | 770-913-8085
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Provider Business Mailing Address
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Address Line | 705 BREEDLOVE DR SUITE 200
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City | MONROE
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State | GA
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Zip | 30655-2090
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Country | US
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Telephone | 770-266-0351
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Fax | 770-266-0313
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JENNIFER VIRGILIO
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Credential |
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Telephone | 770-207-7859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 051832
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License Number State | GA
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