Organization
THE SOUTHEAST PERMANENTE MEDICAL GROUP
Active
Organization
THE SOUTHEAST PERMANENTE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL DOHERTY (ASSOCIATE MEDICAL DIRECTOR)
(404) 364-2245
Entity
Organization
Contact information
Practice address
3495 PIEDMONT ROAD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1773
(404) 364-3821
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1773
(404) 364-3821
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208M00000X
Hospitalist Physician
—
—
213E00000X
Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Enumeration date
06/24/2006
Last updated
07/18/2017
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