Organization
MPPG, INC.
Active
Other names
Memorial Urgent Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
110 MEDICAL PARK DR, POOLER, GA 31322-1956
(921) 748-1515
(912) 748-7707
Mailing address
110 MEDICAL PARK DR, POOLER, GA 31322-1956
(921) 748-1515
(912) 748-7707
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30003167A
—
GA
01
—
CH5121
RAILROAD MEDICARE
GA
Enumeration date
03/06/2013
Last updated
05/13/2014
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