Organization
NORTHEAST INTERNAL MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARILYN DIGAMON-BELTRAN MD (PRESIDENT CEO)
(770) 267-9484
Entity
Organization
Contact information
Practice address
333 ALCOVY ST, SUITE 8, MONROE, GA 30655-2180
(770) 267-9484
(770) 267-1600
Mailing address
333 ALCOVY ST, SUITE 8, MONROE, GA 30655-2180
(770) 267-9484
(770) 267-1600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
065514
GA
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
027031
GA
207RI0200X
Infectious Disease Physician
065514
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000299912A
—
GA
05
—
003124228A
—
GA
01
—
027031
LICENSE NUMBER
GA
01
—
065514
LICENSE NUMBER
GA
01
—
1639254881
NPI
GA
01
—
1912194960
NPI
GA
01
—
202I118301
PTAN
GA
01
—
3692
GRP PTAN
GA
Enumeration date
03/13/2007
Last updated
09/18/2012
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