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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