Provider Demographics
NPI:1215132725
Name:NETPHYSICIAN INC
Entity type:Organization
Organization Name:NETPHYSICIAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-957-0156
Mailing Address - Street 1:5700 LAKE MANOR TRCE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2613
Mailing Address - Country:US
Mailing Address - Phone:678-957-0156
Mailing Address - Fax:678-935-3994
Practice Address - Street 1:3039 AMWILER RD
Practice Address - Street 2:SUITE 118
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2824
Practice Address - Country:US
Practice Address - Phone:770-326-6143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA038561207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1699895961OtherPROVIDENCE CLINICAL #
GA1073739249OtherFRANK PETER MATALONE, DO