MEDICARE: ETOWAH EMERGENCY PHYSICIANS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1306388343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETOWAH EMERGENCY PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 21663
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4113
Country	:	US
Telephone Number	:	770-874-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 ROCKMART HWY
Second Line	:
City	:	CEDARTOWN
State	:	GA
Zip	:	30125-6029
Country	:	US
Telephone Number	:	770-748-2500
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	KIM H LARSEN
Credential	:
Telephone Number	:	770-874-5400

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	02/19/2026

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