Organization
NORTHEAST GEORGIA PHYSICIANS GROUP, INC.
Active
Organization
NORTHEAST GEORGIA PHYSICIANS GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. J. SHANNON GLOVER (EXEC. DIRECTOR MANAGED CARE)
(770) 219-7826
Entity
Organization
Contact information
Practice address
115 TOWNE CENTER PKWY, SUITE 113, HOSCHTON, GA 30548-2213
(706) 658-2452
(706) 658-2462
Mailing address
115 TOWNE CENTER PKWY, SUITE 113, HOSCHTON, GA 30548-2213
(706) 658-2452
(706) 658-2462
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
60363
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
574554373A
—
GA
Enumeration date
12/14/2007
Last updated
04/15/2011
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