Organization
MPPG, INC.
Active
Other names
MHUP - Eisenhower Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
340 EISENHOWER DR, 1200, SAVANNAH, GA 31406-1600
(912) 443-4200
(912) 355-8124
Mailing address
PO BOX 102032, MHUP - EISENHOWER MEDICAL ASSOCIATES, ATLANTA, GA 30368-2032
(912) 443-4200
(912) 355-8124
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPA968
—
SC
Enumeration date
06/17/2008
Last updated
06/01/2011
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