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General NPI Number Information
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NPI Number | 1629586698
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA PHYSICAL MEDICINE
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 6030 BETHELVIEW RD STE 502
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City | CUMMING
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State | GA
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Zip | 30040-8025
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Country | US
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Telephone | 770-888-8292
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Fax | 770-888-9858
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Provider Business Mailing Address
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Address Line | 6030 BETHELVIEW RD STE 502
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City | CUMMING
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State | GA
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Zip | 30040-8025
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Country | US
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Telephone | 770-888-8292
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Fax | 770-888-9858
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Authorized Official
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Title or Position | OWNER
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Name | JOHN DEMBOSKI
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Credential |
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Telephone | 770-888-8292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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