Organization
MPPG, INC.
Active
Other names
Memorial Health Screven County
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
105 ROCKY FORD ROAD, SYLVANIA, GA 30467
(912) 564-7133
(912) 564-2619
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(912) 564-7133
(912) 564-2619
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/06/2006
Last updated
06/01/2011
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