Provider Demographics
NPI:1407293905
Name:CONCIERGE MEDICINE LLC
Entity Type:Organization
Organization Name:CONCIERGE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMBACH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:770-945-1990
Mailing Address - Street 1:4720 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3480
Mailing Address - Country:US
Mailing Address - Phone:770-945-1990
Mailing Address - Fax:770-945-3631
Practice Address - Street 1:4720 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3480
Practice Address - Country:US
Practice Address - Phone:770-945-1990
Practice Address - Fax:770-945-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty