MEDICARE: GEPS PHYSICIAN GROUP OF GEORGIA PC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1881064467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEPS PHYSICIAN GROUP OF GEORGIA PC

Provider Business Mailing Address
First Line	:	PO BOX 42738
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21284-2738
Country	:	US
Telephone Number	:	410-494-7607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 SPRINGDALE RD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7802
Country	:	US
Telephone Number	:	404-762-8672
Fax Number	:

Authorized Official
Title or Position	:	VP/AREA CONTROLLER
Name	:	ERIC SHAPIRO
Credential	:
Telephone Number	:	410-832-7790

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	08/05/2019

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