NORTHEAST GEORGIA PHYSICIANS GROUP, INC. (NPI# 1104009059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104009059 |
| Entity Type | Organization |
| Organization Name | NORTHEAST GEORGIA PHYSICIANS GROUP, INC. |
| Practice Address |
115 Towne Center Pkwy Suite 113 Hoschton GA 30548-2213 |
| Practice Telephone | 7066582452 |
| Practice Fax Number | 7066582462 |
| Mailing Telephone | 7066582452 |
| Mailing Fax Number | 7066582462 |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2011-04-15 |
| Authorized Official Name | MR. J. SHANNON GLOVER (EXEC. DIRECTOR MANAGED CARE) |
| Authorized Official Telephone | 7702197826 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
60363 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 574554373A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134749211 | Northeast Georgia Physicians Group, Inc. | Allergy & Immunology | 1515 River Pl Ste 380, Braselton, GA 30517-5605 | 2020-04-20 |
| 1538103049 | Northeast Georgia Physicians Group, Inc. | Non-emergency Medical Transport (VAN) | 665 Lanier Park Dr, Gainesville, GA 30501-2059 | 2006-06-15 |
| 1699395772 | Northeast Georgia Physicians Group, Inc. | Allergy & Immunology | 2510 Limestone Pkwy, Gainesville, GA 30501-2089 | 2020-04-20 |
| 1891745212 | Northeast Georgia Physicians Group, Inc. | Psychiatry & Neurology | 743 Spring St Ne, Gainesville, GA 30501-3715 | 2006-05-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | NORTHEAST GEORGIA PHYSICIANS GROUP, INC. | 601 S Enota Dr Ne Ste P, Gainesville, GA 30501-2544 |
| Street Address |
115 TOWNE CENTER PKWY SUITE 113 |
| City | HOSCHTON |
| State | GA |
| Zip Code | 30548-2213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427505221 | Ovram Inc. | Durable Medical Equipment & Medical Supplies | 115 Towne Center Pkwy, Suite 115, Hoschton, GA 30548-2213 | 2016-09-08 |
| 1548622285 | Four Corners Primary Care Centers Inc | Clinic/Center | 115 Towne Center Pkwy, Suite 113, Hoschton, GA 30548-2213 | 2016-03-22 |
| 1881912178 | A. Louis Jimenez, Dpm, PC | Podiatrist | 115 Towne Center Pkwy, Hoschton, GA 30548-2213 | 2010-05-11 |
| 1649408667 | Marissa Maricel Armamento Mercado | Family Medicine | 115 Towne Center Pkwy, Suite #113, Hoschton, GA 30548-2213 | 2009-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386108587 | Lan Tran Schlecht | Social Worker | 255 Lamar Ln, Hoschton, GA 30548 | 2019-01-22 |
| 1265932560 | Carley Costner | Chiropractor | 280 Cambridge Farms Dr, Hoschton, GA 30548 | 2018-02-14 |
| 1285906263 | Loving Hearts Helping Hands Senior Homecare | Home Health | 2011 Maddox Road, Hoschton, GA 30548 | 2012-02-06 |
| 1588967376 | Pamela Ann Reagin | Massage Therapist | 4397 Hwy 53, Hoschton, GA 30548 | 2010-12-16 |
| 1144523176 | David Chandler Bell | Chiropractor | 55 Freedom Parkway, Suite 112, Hoschton, GA 30548 | 2010-12-14 |
| 1275781361 | Georgia Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 5848 Hwy 124 West, Hoschton, GA 30548 | 2008-09-03 |
| 1972635407 | Cognitive Behavioral Health LLC | Counselor | 5415 Thompson Mill Road Ste B, Dr Devin Vicknair, Hoschton, GA 30548 | 2007-03-10 |
| 1336203454 | Robert Lee Cornett | Physical Therapist | 5415 Thompson Mill Road, Hoschton, GA 30548 | 2006-12-21 |
| 1790846426 | West Jackson Medicine Center, Inc | Durable Medical Equipment & Medical Supplies | 3845 Hwy 53, Hoschton, GA 30548 | 2006-12-13 |
| 1235140773 | Jennifer Hawk Wiley | Chiropractor | 117 Bell Avenue, Hoschton, GA 30548 | 2006-08-10 |
| Find all providers in zip 30548 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992916753 | Chadwick Marshall Palmer | Family Medicine | 5875 Thompson Mill Rd, Suite 280, Hoschton, GA 30548-4133 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306108279 | Casey Wagner | Family Medicine | 7813 Spivey Station Blvd Ste 220, Jonesboro, GA 30236 | 2012-06-15 |
| 1831422682 | Koji Nishimura | Family Medicine | Commander, Usameddac and Martin Army Community Hospital, 7950 Martin Loop, Fort Benning, GA 31905 | 2009-09-11 |
| 1073787305 | Mark James Sakr | Family Medicine | 3400 Old Milton Pkwy Ste C190, Alpharetta, GA 30005-4481 | 2008-04-17 |
| 1366549073 | Michael Joseph Huey | Family Medicine | Emory University Student Health Services, 1525 Clifton Road, Atlanta, GA 30322-0001 | 2006-09-17 |
| 1942234281 | Charles Edward Garten II | Family Medicine | 3200 Downwood Cir Nw Ste 340, Atlanta, GA 30327-1605 | 2006-07-11 |
| 1477597979 | John M. Henderson Sr. | Family Medicine | 1900 10th Ave Suite 320, Columbus, GA 31901 | 2006-06-15 |
| 1609843481 | Tracy R Ray | Family Medicine | 1305 Jennings Mill Rd Ste 110, Watkinsville, GA 30677-7241 | 2006-03-01 |
| 1982679684 | John Michael Buchanan | Family Medicine | 3575 Braselton Hwy, Dacula, GA 30019-1155 | 2006-02-17 |
| 1770562852 | Neeru Jayanthi | Family Medicine | 6335 Hospital Pkwy Ste 302, Emory Orthopaedics, Sports, Spine, Johns Creek, GA 30097-5712 | 2006-01-17 |
| 1255972840 | Chelsey Beckham | Family Medicine | 400 Arnold Mill Rd, Woodstock, GA 30188-2834 | 2019-10-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.