Premier South Medical Group PC
Family Medicine in Newnan, GA. Organization (NPI-2).
NPI number1669916573
StatusActive
Last updated in NPPESDec 19, 2016
Details
- NPI
- 1669916573
- Entity type
- Organization (NPI-2)
- Legal business name
- Premier South Medical Group PC
- Organization subpart
- No
- Enumeration date
- Dec 12, 2016
- Last updated
- Dec 19, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
770 Greison TrlSuite F
Newnan, GA 30263-6408
Phone 770-251-4120 · Fax 770-251-4575
Mailing address
8750 Nw 36th StSuite 300
Doral, FL 33178-2425
Phone 786-641-5348 · Fax 305-615-1121
Authorized official
Reanna Ramkhelawan
Contracting Specialist
7862812398
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