Provider Demographics
NPI:1073702312
Name:CHESTATEE EMERGENT MEDICAL CARE
Entity Type:Organization
Organization Name:CHESTATEE EMERGENT MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BERLINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-265-6866
Mailing Address - Street 1:2395 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-5376
Mailing Address - Country:US
Mailing Address - Phone:706-265-6866
Mailing Address - Fax:706-216-8448
Practice Address - Street 1:2395 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-5376
Practice Address - Country:US
Practice Address - Phone:706-265-6866
Practice Address - Fax:706-216-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041262261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4665Medicare PIN