Organization
NORTHEAST GEORGIA PHYSICIANS GROUP URGENT CARE LLC
Active
Parent organization
NORTHEAST GEORGIA PHYSICIANS GROUP, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST GEORGIA PHYSICIANS GROUP, INC
Authorized official
LISA HERNANDEZ (EXECUTIVE DIRECTOR)
(770) 219-8420
Entity
Organization
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 219-8420
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
(770) 219-8440
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP 7942
MEDICARE GRP
GA
Enumeration date
10/16/2006
Last updated
05/16/2023
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