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General NPI Number Information
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NPI Number | 1699021576
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Entity Type | Organization
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Legal Business Name | COMMERCE PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 70 MEDICAL CENTER DR
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City | COMMERCE
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State | GA
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Zip | 30529-1078
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Country | US
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Telephone | 706-335-1113
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Fax |
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Provider Business Mailing Address
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Address Line | 70 MEDICAL CENTER DR
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City | COMMERCE
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State | GA
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Zip | 30529-1078
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Country | US
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Telephone | 706-335-1113
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | LARRY EBERT
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Credential |
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Telephone | 706-335-1113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 001437
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License Number State | GA
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