Provider Demographics
NPI:1174005847
Name:NORTHEAST GEORGIA DIAGNOSTIC ASSOCIATES AND CLINIC, LLC
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA DIAGNOSTIC ASSOCIATES AND CLINIC, LLC
Other - Org Name:NGDC SLEEP MED LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP ADMIN./CCO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-851-6378
Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE STE 600
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3863
Mailing Address - Country:US
Mailing Address - Phone:770-536-9864
Mailing Address - Fax:
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE STE 500
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3861
Practice Address - Country:US
Practice Address - Phone:770-536-9864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies