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General NPI Number Information
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NPI Number | 1932321338
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA MEDICAL CENTER
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 5015 ARBOR CREEK COURT
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City | CUMMING
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State | GA
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Zip | 30040
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Country | US
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Telephone | 678-947-3445
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Fax | 678-947-3445
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Provider Business Mailing Address
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Address Line | 5015 ARBOR CREEK COURT
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City | CUMMING
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State | GA
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Zip | 30040
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Country | US
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Telephone | 678-947-3445
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Fax | 678-947-3445
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Authorized Official
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Title or Position | SUPERVISOR OF ACUTE AND INPATIENT R
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Name | MRS. LIZ JACKSON
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Credential | P.T. MBA
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Telephone | 770-535-3469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT004146
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License Number State | GA
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