Provider Demographics
NPI:1174024376
Name:FORT OGLETHORPE EMERGENCY PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:FORT OGLETHORPE EMERGENCY PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOYKIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-500-8147
Mailing Address - Street 1:400 GALLERIA PKWY SE STE 1755
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5934
Mailing Address - Country:US
Mailing Address - Phone:404-500-8147
Mailing Address - Fax:405-341-9217
Practice Address - Street 1:2855 OLD HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6248
Practice Address - Country:US
Practice Address - Phone:323-486-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0192OtherMEDICARE