| Organization Name: | CMG1, LLC |
| NPI Number: | 1033522420 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN B COOPER (ADMINISTRATOR) |
| Mailing Address: | 6487 Pierce Chapel Rd Unit 5 Midland |
| State: | GA US |
| Postal Code: | 318203554 |
| Phone Number: | 8772987705 |
| Fax Number: | 8668379033 |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 06/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204C00000X |
| License Number: | 56072 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |