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General NPI Number Information
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NPI Number | 1134522774
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Entity Type | Organization
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Legal Business Name | PHYSICIAN'S GROUP OF GEORGIA
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 5755 N POINT PKWY SUITE 53
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City | ALPHARETTA
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State | GA
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Zip | 30022-1142
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Country | US
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Telephone | 404-382-9608
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Fax |
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Provider Business Mailing Address
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Address Line | 5755 N POINT PKWY SUITE 53
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City | ALPHARETTA
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State | GA
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Zip | 30022-1142
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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 | DIRECTOR OF OPERATIONS
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Name | JESSE ANDERSON
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Credential |
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Telephone | 404-382-9608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6242
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License Number State | GA
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