Provider Demographics
NPI:1114529757
Name:AMG MEDICAL GROUP (DE), P.A.
Entity type:Organization
Organization Name:AMG MEDICAL GROUP (DE), P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-362-2559
Mailing Address - Street 1:7600 CHEVY CHASE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1599
Mailing Address - Country:US
Mailing Address - Phone:844-362-2559
Mailing Address - Fax:
Practice Address - Street 1:4900 HOPYARD RD STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-7101
Practice Address - Country:US
Practice Address - Phone:561-901-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty