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General NPI Number Information
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NPI Number | 1730804642
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Entity Type | Organization
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Legal Business Name | NGX LAWRENCEVILLE GA PC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 1470 LAWRENCEVILLE HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-4646
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Country | US
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Telephone | 678-486-7777
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Fax | 678-486-7777
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Provider Business Mailing Address
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Address Line | 1470 LAWRENCEVILLE HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-4646
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Country | US
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Telephone | 678-486-7777
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Fax | 678-486-7777
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Authorized Official
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Title or Position | PATIENT SERVICE CENTER MANAGER
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Name | RICHARD GRACIANO
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Credential |
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Telephone | 915-261-9418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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