Organization
NGDC SLEEP MED LAB
Active
Parent organization
NE GA DIAGNOSTIC CLINIC LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NE GA DIAGNOSTIC CLINIC LLC
Authorized official
DR. WESLEY D HEAD MD (DIRECTOR)
(770) 536-9864
Entity
Organization
Contact information
Practice address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5023
Mailing address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5023
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
40404
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51000159001
BCBS Q CARE NUMBER
GA
Enumeration date
03/05/2009
Last updated
09/20/2017
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