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NPI Code Detail

MEDICARE: NORTHEAST GEORGIA PHYSICIANS GROUP URGENT CARE LLC

MEDICARE: NORTHEAST GEORGIA PHYSICIANS GROUP URGENT CARE 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
1363LA2200XAdult Health Nurse Practitioner
2363L00000XNurse Practitioner
3207P00000XEmergency Medicine Physician
4207QS0010XSports Medicine (Family Medicine) Physician
5207R00000XInternal Medicine Physician
6363A00000XPhysician Assistant
7261QU0200XUrgent Care Clinic/Center
8208D00000XGeneral Practice Physician
9207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GRP 7942OTHERGAMEDICARE GRP

General Provider Information

NPI Number : 1790875037
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST GEORGIA PHYSICIANS GROUP URGENT CARE LLC
Provider Business Mailing Address
First Line : PO BOX 742616
Second Line :
City : ATLANTA
State : GA
Zip : 30374-2616
Country : US
Telephone Number : 770-219-8420
Fax Number : 770-219-8440
Provider Business Practice Location Address
First Line : 743 SPRING ST NE
Second Line :
City : GAINESVILLE
State : GA
Zip : 30501-3715
Country : US
Telephone Number : 770-219-8420
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : LISA HERNANDEZ
Credential :
Telephone Number : 770-219-8420
Provider Enumeration Date : 10/16/2006
Last Update Date : 06/14/2026

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