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General NPI Number Information
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NPI Number | 1699395772
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA PHYSICIANS GROUP, INC.
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Dates
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Enumeration Date | 04/20/2020
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Last Update Date | 04/20/2020
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Provider Practice Location Address
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Address Line | 2510 LIMESTONE PKWY
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City | GAINESVILLE
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State | GA
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Zip | 30501-2089
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Country | US
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Telephone | 770-219-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 LIMESTONE PKWY
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City | GAINESVILLE
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State | GA
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Zip | 30501-2089
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Country | US
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Telephone | 770-219-9500
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF PHYSICIAN SER
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Name | SHELBY ANN DODD
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Credential |
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Telephone | 770-219-8453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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