Provider Demographics
NPI:1427484963
Name:PHYSICIAN MANAGEMENT & CONSULTING
Entity type:Organization
Organization Name:PHYSICIAN MANAGEMENT & CONSULTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WES
Authorized Official - Middle Name:
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-433-0044
Mailing Address - Street 1:1050 SHILOH RD NW
Mailing Address - Street 2:SUITE 311
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7194
Mailing Address - Country:US
Mailing Address - Phone:404-433-0044
Mailing Address - Fax:
Practice Address - Street 1:1050 SHILOH RD NW
Practice Address - Street 2:SUITE 311
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7194
Practice Address - Country:US
Practice Address - Phone:404-433-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty