Provider Demographics
NPI:1174841696
Name:EAST ATLANTA INFECTIOUS DISEASE LLC
Entity Type:Organization
Organization Name:EAST ATLANTA INFECTIOUS DISEASE LLC
Other - Org Name:NEWTON HEALTH SYSTEM INC SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, NEWTON MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-385-4183
Mailing Address - Street 1:5126 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2566
Mailing Address - Country:US
Mailing Address - Phone:770-385-4183
Mailing Address - Fax:770-385-4281
Practice Address - Street 1:7143 TURNER LAKE RD NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2066
Practice Address - Country:US
Practice Address - Phone:770-787-4504
Practice Address - Fax:770-788-9875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-07
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062557207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty