Provider Demographics
NPI:1275035578
Name:PERSONAL CONCIERGE MD, LLC
Entity Type:Organization
Organization Name:PERSONAL CONCIERGE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:THADEOUS
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-395-7046
Mailing Address - Street 1:11770 HAYNES BRIDGE ROAD
Mailing Address - Street 2:SUITE 205-#305
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009
Mailing Address - Country:US
Mailing Address - Phone:678-395-7046
Mailing Address - Fax:678-395-3486
Practice Address - Street 1:10105 WESTSIDE PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009
Practice Address - Country:US
Practice Address - Phone:678-395-7046
Practice Address - Fax:678-395-3486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONAL CONCIERGE MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-02
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty