Provider Demographics
NPI:1316716251
Name:NORTHEAST GEORGIA PHYSICIANS GROUP-URGENT CARE, LLC
Entity type:Organization
Organization Name:NORTHEAST GEORGIA PHYSICIANS GROUP-URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-219-8051
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-0018
Mailing Address - Country:US
Mailing Address - Phone:770-219-8351
Mailing Address - Fax:
Practice Address - Street 1:4445 S LEE ST STE 105
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8806
Practice Address - Country:US
Practice Address - Phone:770-848-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care