Provider Demographics
NPI:1417078148
Name:GEORGIA MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:GEORGIA MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-985-5202
Mailing Address - Street 1:2121 FOUNTAIN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7023
Mailing Address - Country:US
Mailing Address - Phone:770-985-5202
Mailing Address - Fax:770-985-9322
Practice Address - Street 1:2121 FOUNTAIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7023
Practice Address - Country:US
Practice Address - Phone:770-985-5202
Practice Address - Fax:770-985-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD46299Medicare UPIN