# NORTHEAST GEORGIA MEDICAL CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northeast Georgia Medical Center Pharmacy-Braselton
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992169197
- **Authorized official:** BRIAN D STEINES (CFO)
- **Authorized official phone:** (770) 219-3562

## Contact information

- **Practice address:** 1515 RIVER PL STE 180, BRASELTON, GA 30517-5603
- **Practice address phone:** (770) 848-6337
- **Practice address fax:** (770) 848-6338
- **Mailing address:** PO BOX 741891, ATLANTA, GA 30374-1891
- **Mailing address phone:** (770) 848-6337
- **Mailing address fax:** (770) 848-6338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE010289 | GA | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/13/2016
- **Last updated:** 04/22/2020