Provider Demographics
NPI:1073049953
Name:SYNERGY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SYNERGY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERD AGEN
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-230-7138
Mailing Address - Street 1:227 SANDY SPRINGS PL
Mailing Address - Street 2:STE. D-120
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6690 ROSWELL RD
Practice Address - Street 2:STE.520
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3161
Practice Address - Country:US
Practice Address - Phone:678-999-8531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty