Provider Demographics
NPI:1063795573
Name:MEDICS OF NORTHEAST GEORGIA, INCORPORATED
Entity type:Organization
Organization Name:MEDICS OF NORTHEAST GEORGIA, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COSSIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-476-0111
Mailing Address - Street 1:1075 S MAIN ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2033
Mailing Address - Country:US
Mailing Address - Phone:706-476-0111
Mailing Address - Fax:
Practice Address - Street 1:13375 JONES ST
Practice Address - Street 2:SUITE D
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-1147
Practice Address - Country:US
Practice Address - Phone:706-476-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies