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NPI 1407308711

NPI 1407308711 : PREMISE HEALTH OF GEORGIA MEDICAL PC : CLAYTON, GA

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General NPI Number Information
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    NPI Number           |    1407308711
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    Entity Type          |    Organization 
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    Legal Business Name  |    PREMISE HEALTH OF GEORGIA MEDICAL PC 
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Dates
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    Enumeration Date     |    11/03/2016
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    Last Update Date     |    02/04/2026
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Provider Practice Location Address
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    Address Line         |    173 W SAVANNAH ST 
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    City                 |    CLAYTON
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    State                |    GA
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    Zip                  |    30525-5096
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    Country              |    US
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    Telephone            |    706-960-9846
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    Fax                  |    706-960-9990
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Provider Business Mailing Address
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    Address Line         |    5500 MARYLAND WAY STE 400 
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    City                 |    BRENTWOOD
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    State                |    TN
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    Zip                  |    37027-7048
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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    |    PRESIDENT
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    Name                 |     EDWARD WILLIAM SCHWARTZ 
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    Credential           |    
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    Telephone            |    844-407-7557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    261QM1300X
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    Taxonomy Name        |    Multi-Specialty Clinic/Center
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    License Number       |    
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    License Number State |    
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