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General NPI Number Information
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NPI Number | 1124776349
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA MEDICAL CENTER INC
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 743 SPRING ST NE STE 735B
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City | GAINESVILLE
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State | GA
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Zip | 30501-3715
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Country | US
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Telephone | 770-219-2265
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 741891
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City | ATLANTA
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State | GA
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Zip | 30374-1891
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PFS MANAGER
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Name | MS. YAVONDA HAYNES
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Credential |
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Telephone | 770-219-5944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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