# NORTHEAST GEORGIA MEDICAL HABERSHAM LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508644915
- **Authorized official:** MR. BRIAN D STEINES (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (770) 219-1703

## Contact information

- **Practice address:** 541 HISTORIC HIGHWAY 441 N, SUITE 1, DEMOREST, GA 30535
- **Practice address phone:** (706) 754-2273
- **Mailing address:** PO BOX 741891, ATLANTA, GA 30374-1891

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/18/2023
- **Last updated:** 09/18/2023