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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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