Organization Name: | NORTHEAST GA MIDLEVEL SERVICES |
NPI Number: | 1811321011 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINE ANDERSON (OWNDER) |
Mailing Address: | 2800 Crane Mill Rd Alto |
State: | GA US |
Postal Code: | 305103621 |
Phone Number: | 7063383898 |
Fax Number: | 8883538976 |
NPI Enumeration Date: | 08/25/2013 |
NPI Last Update Date: | 08/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 4789 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |