GEORGIA STARS MEDICAL CLINIC, LLC (NPI# 1255989794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1255989794 |
Entity Type | Organization |
Organization Name | GEORGIA STARS MEDICAL CLINIC, LLC |
Practice Address |
142 Old Mill Rd Lagrange GA 30241-6704 |
Practice Telephone | 7068851900 |
Practice Fax Number | 7068821350 |
Mailing Telephone | 7068851900 |
Mailing Fax Number | 7068821350 |
Enumeration Date | 2019-08-28 |
Last Update Date | 2019-08-28 |
Authorized Official Name | DR. QUOC VINH NGO (OWNER) |
Authorized Official Telephone | 7068851900 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | MEDICAL LICENSE | 80387 | 01 |
Street Address |
142 OLD MILL RD |
City | LAGRANGE |
State | GA |
Zip Code | 30241-6704 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1831422484 | West Georgia Medical Group-lagrange | Internal Medicine | 142 Old Mill Rd, Lagrange, GA 30241-6704 | 2009-09-15 |
1275030819 | Nephrology Consultants of West Georgia | Internal Medicine | 142 Old Mill Rd, Lagrange, GA 30241-6704 | 2018-04-10 |
1972021392 | Amanda Caldwell Knight | Nurse Practitioner | 142 Old Mill Rd, Lagrange, GA 30241-6704 | 2017-09-06 |
1184935892 | Kelly Dudley Jones | Nurse Practitioner | 142 Old Mill Rd, Lagrange, GA 30241-6704 | 2010-06-28 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073994182 | Pathways Center for Behavioral and Developmental Growth | Community/Behavioral Health | 102 Corporate Park Drive East, Lagrange, GA 30241 | 2015-06-15 |
1235303686 | Atlas Neck & Back Center | Chiropractor | 309 N. Morgan St., Suite A, Lagrange, GA 30241 | 2008-04-16 |
1578756565 | Richard Freeman Simmons | Dentist | 2219 B West Point Rd, Dr Richard F Simmons, Lagrange, GA 30241 | 2007-08-22 |
1013071851 | Troup County School District | Local Education Agency (LEA) | 100 North Davis Road, Lagrange, GA 30241 | 2006-12-19 |
1851748172 | Medventures Physical Therapy, LLC | Physical Therapist | 1075 Lafayette Parkway, Ste 220, Lagrange, GA 30241 | 2016-05-17 |
1154784205 | Med Ventures Mri, LLC | Radiology | 1075 Lafayette Parkway, Ste 120, Lagrange, GA 30241 | 2016-04-05 |
1437514965 | Holly Renee Abbott | Counselor | 104 Harwell Ave, Lagrange, GA 30241 | 2015-12-29 |
1386780104 | Andre D Feria Md | Internal Medicine | 142 Old Mill Road, Lagrange, GA 30241 | 2007-01-29 |
1356354500 | Mohd Khairul Anam | Internal Medicine | 142 Old Mill Road, Lagrange, GA 30241 | 2006-08-15 |
1417914052 | Troup County Health Department | Public Health or Welfare | 1220 Hogansville Rd, Department of Family and Childrens Services Health Cent, Lagrange, GA 30241 | 2006-04-27 |
Find all providers in zip 30241 |
Taxonomy Code | 207R00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
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 Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598077398 | Leslie Jean Ogilvy | Internal Medicine | 1524 Lafayette Pkwy, Lagrange, GA 30241-2566 | 2010-07-08 |
1831422484 | West Georgia Medical Group-lagrange | Internal Medicine | 142 Old Mill Rd, Lagrange, GA 30241-6704 | 2009-09-15 |
1578727293 | Ifeoma A Ojukwu | Internal Medicine | 147 Mallard Creek Run, Lagrange, OH 44050-9803 | 2008-07-11 |
1326241514 | Ronald William Mcquigg | Internal Medicine | 218 East Av, Lagrange, IL 60525 | 2007-06-06 |
1578698429 | Frederick William Kemen | Internal Medicine | Kentucky State Reformatory, 3001 W. Highway 146, Lagrange, KY 40032-0002 | 2007-02-22 |
1245307735 | Gary S Griffin | Internal Medicine | 1600 Vernon Rd, Suite G, Lagrange, GA 30240-4143 | 2006-11-29 |
1134183742 | Ravina V Kadam | Internal Medicine | 300 Medical Dr Ste 704, Lagrange, GA 30240-4130 | 2006-04-12 |
1174518500 | Northeast Internal Medicine Associates,p.c | Internal Medicine | 2500 N Detroit St, Lagrange, IN 46761-1158 | 2005-09-12 |
1255333456 | Amir Usman | Internal Medicine | 1602 Vernon Rd, Ste 400, Lagrange, GA 30240-4100 | 2005-06-01 |
1508868704 | Anil R Modi | Internal Medicine | 300 Medical Dr, Suite 701, Lagrange, GA 30240-4130 | 2005-06-01 |
Find all providers in LAGRANGE |
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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.