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General NPI Number Information
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NPI Number | 1992169197
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA MEDICAL CENTER, INC
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 1515 RIVER PL STE 180
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City | BRASELTON
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State | GA
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Zip | 30517-5603
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Country | US
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Telephone | 770-848-6337
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Fax | 770-848-6338
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Provider Business Mailing Address
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Address Line | PO BOX 741891
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City | ATLANTA
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State | GA
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Zip | 30374-1891
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Country | US
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Telephone | 770-848-6337
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Fax | 770-848-6338
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Authorized Official
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Title or Position | CFO
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Name | BRIAN D STEINES
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Credential |
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Telephone | 770-219-3562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010289
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License Number State | GA
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