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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