Provider Demographics
NPI:1407892706
Name:NORTHEAST GEORGIA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA MEDICAL CENTER, INC.
Other - Org Name:NEW HORIZONS LANIER PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-219-3562
Mailing Address - Street 1:675 WHITE SULPHUR ROAD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2569
Mailing Address - Country:US
Mailing Address - Phone:770-219-8300
Mailing Address - Fax:770-219-8329
Practice Address - Street 1:675 WHITE SULPHUR ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2621
Practice Address - Country:US
Practice Address - Phone:770-219-8300
Practice Address - Fax:770-219-8329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST GEORGIA MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141072AMedicaid
GA00141072AMedicaid
GA00141072AMedicaid