# NORTHEAST GEORGIA PHYSICIANS GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTHEAST GEORGIA HEALTH SYSTEM, INC.
- **Other names:** MEDICAL TRANSPORT
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1538103049
- **Legal business name:** NORTHEAST GEORGIA HEALTH SYSTEM, INC.
- **Authorized official:** MR. ANTHONY M. HERDENER (VICE-PRESIDENT & CFO)
- **Authorized official phone:** (770) 219-9000

## Contact information

- **Practice address:** 665 LANIER PARK DR, GAINESVILLE, GA 30501-2059
- **Practice address phone:** (770) 219-0303
- **Practice address fax:** (770) 219-0561
- **Mailing address:** 743 SPRING ST NE, GAINESVILLE, GA 30501-3715
- **Mailing address phone:** (770) 219-9000
- **Mailing address fax:** (770) 219-0561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 154-03 | GA | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | GA | — |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 06/20/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00793625B | — | GA |