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General NPI Number Information
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NPI Number | 1215889126
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Entity Type | Organization
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Legal Business Name | SANDY PLAINS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 3225 SHALLOWFORD RD STE 1300
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City | MARIETTA
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State | GA
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Zip | 30062-7033
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Country | US
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Telephone | 678-560-7160
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 SHALLOWFORD RD STE 1300
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City | MARIETTA
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State | GA
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Zip | 30062-7033
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Country | US
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Telephone | 678-560-7160
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JUSTIN GLAESER
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Credential |
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Telephone | 678-560-5278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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