Organization
NORTH GEORGIA UROLOGY CENTER, PC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLISTA TALLENT (PRACTICE MANAGER)
(706) 278-5961
Entity
Organization
Contact information
Practice address
1434 BROADRICK DRIVE, NORTH GEORGIA UROLOGY CENTER, DALTON, GA 30720
(706) 278-5961
(706) 275-0280
Mailing address
1434 BROADRICK DRIVE, DALTON, GA 30720-3009
(706) 278-5961
(706) 275-0280
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
050482
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00931312A
—
GA
05
—
429126502A
—
GA
05
—
8913681
—
GA
Enumeration date
07/21/2006
Last updated
10/04/2018
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