Organization
THE BRASELTON CLINIC
Active
Parent organization
NORTHEAST GEORGIA PRIMARY CARE, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST GEORGIA PRIMARY CARE, INC.
Authorized official
MARK KLEIN (EXECUTIVE DIRECTOR)
(770) 533-8406
Entity
Organization
Contact information
Practice address
5875 THOMPSON MILL RD, STE. 200, HOSCHTON, GA 30548-4001
(770) 965-2022
(770) 967-6325
Mailing address
601 S ENOTA DR NE, SUITE Q, GAINESVILLE, GA 30501-2400
(770) 533-8400
(770) 533-8409
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511G700042
MEDICARE GROUP ID
GA
Enumeration date
08/23/2007
Last updated
11/24/2008
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