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General NPI Number Information
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NPI Number | 1356472914
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Entity Type | Organization
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Legal Business Name | PREMIER IMMEDIATE CARE OF GEORGIA, PC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 289 GRAYSON HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5726
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Country | US
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Telephone | 678-376-1300
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Fax | 678-407-1469
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Provider Business Mailing Address
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Address Line | PO BOX 8581
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City | BELFAST
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State | ME
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Zip | 04915-8581
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Country | US
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Telephone | 678-376-1300
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Fax | 678-407-1469
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP NORTON HENDERSON
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Credential | MD, MPH, MBA
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Telephone | 678-376-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 047601
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 047601
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 047601
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License Number State | GA
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