Organization
PREMIUM CARE MED GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TED M PENNEL (CEO)
(404) 422-8719
Entity
Organization
Contact information
Practice address
3828 SALEM RD, SUITE 200, COVINGTON, GA 30016-4528
(404) 422-8719
Mailing address
3828 SALEM RD, SUITE 200, COVINGTON, GA 30016-4528
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
029068
GA
Other
Enumeration date
07/16/2009
Last updated
07/16/2009
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