1225723075 NPI number — GEORGIA PHYSICIAN ASSOCIATES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225723075 NPI number — GEORGIA PHYSICIAN ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA PHYSICIAN ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225723075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 VILLAGE PROFESSIONAL DRIVE, STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30114-8499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-661-4545
Provider Business Mailing Address Fax Number:
678-265-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5266 OLD NORCROSS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-661-4545
Provider Business Practice Location Address Fax Number:
678-265-4299
Provider Enumeration Date:
04/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BEECHAM
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
678-661-4545

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com