Provider Demographics
NPI:1538022975
Name:GRUPO MEDICO DE GEORGIA, LLC
Entity type:Organization
Organization Name:GRUPO MEDICO DE GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAJARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-559-3555
Mailing Address - Street 1:4225 S LEE ST STE B
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3872
Mailing Address - Country:US
Mailing Address - Phone:770-559-3555
Mailing Address - Fax:678-730-7777
Practice Address - Street 1:2721 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3240
Practice Address - Country:US
Practice Address - Phone:770-444-9494
Practice Address - Fax:770-436-4656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRUPO MEDICO DE GEORGIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty