MEDICARE: UNITED PHYSICIAN 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

General Provider Information

NPI Number	:	1922579192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PHYSICIAN GROUP LLC

Provider Business Mailing Address
First Line	:	13 CORPORATE BLVD NE STE 100
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-1905
Country	:	US
Telephone Number	:	678-505-9657
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 CORPORATE BLVD NE STE 100
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-1905
Country	:	US
Telephone Number	:	678-505-9657
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTIAN FLETCHER
Credential	:
Telephone Number	:	833-523-0906

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	09/15/2020

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Directions to “UNITED PHYSICIAN GROUP LLC ” Practice Location

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