Organization
NORTHEAST GEORGIA SPECIALTY GROUP LLC
Active
Parent organization
NORTHEAST GEORGIA PRIMARY CARE, INC.
Other names
Neurology Physician Group and Advantage Sports Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST GEORGIA PRIMARY CARE, INC.
Authorized official
MARK KLEIN (EXECUTIVE DIRECTOR)
(770) 533-8406
Entity
Organization
Contact information
Practice address
601 S ENOTA DR NE, SUITE Q, GAINESVILLE, GA 30501-2400
(770) 533-8400
(770) 533-8409
Mailing address
601 S ENOTA DR NE, SUITE Q, GAINESVILLE, GA 30501-2400
(770) 533-8400
(770) 533-8409
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/23/2007
Last updated
04/28/2008
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