Organization
PHYSICIAN MANAGEMENT SERVICES OF EASTERN GEORGIA, LLC
Active
Parent organization
VAXCARE CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAXCARE CORPORATION
Authorized official
BRETT KENEFICK (PRESIDENT)
(888) 829-8550
Entity
Organization
Contact information
Practice address
410 PEACHTREE PKWY, SUITE 4260, CUMMING, GA 30041-7066
(888) 829-8550
Mailing address
3113 LAWTON RD, SUITE 250, ORLANDO, FL 32803-3531
(888) 829-8550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
049380
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHC059
MEDICARE PTAN
—
Enumeration date
03/16/2017
Last updated
03/16/2017
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