Organization
MPPG, INC.
Active
Organization
MPPG, INC.
Active
Other names
Memorial Health Richmond Hill
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SEBRENA HOLMES GIBSON (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
3776 US HIGHWAY 17, RICHMOND HILL, GA 31324-3378
(912) 350-7020
(912) 459-0064
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(912) 756-2292
(912) 756-2289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085001150G
GBHC
GA
05
—
3000031676A
—
GA
01
—
CH5121
RAILROAD MEDICARE GROUP
GA
Enumeration date
11/27/2006
Last updated
06/20/2016
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