MEDICARE: NORTH GEORGIA PRIMARY CARE GROUP 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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689616237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH GEORGIA PRIMARY CARE GROUP LLC

Provider Business Mailing Address
First Line	:	128 BATTLEFIELD CROSSING COURT
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-5176
Country	:	US
Telephone Number	:	706-861-0004
Fax Number	:	706-861-0050

Provider Business Practice Location Address
First Line	:	128 BATTLEFIELD CROSSING CT
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-5176
Country	:	US
Telephone Number	:	706-861-0004
Fax Number	:	706-861-0050

Authorized Official
Title or Position	:	VP
Name	:	GARY DUNCAN
Credential	:
Telephone Number	:	615-373-7600

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/13/2008

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