Provider Demographics
NPI:1437786357
Name:GENMEDGA, LLC
Entity Type:Organization
Organization Name:GENMEDGA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:770-324-9986
Mailing Address - Street 1:303 KIMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-6340
Mailing Address - Country:US
Mailing Address - Phone:770-324-9986
Mailing Address - Fax:
Practice Address - Street 1:230 EAST AVE
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3002
Practice Address - Country:US
Practice Address - Phone:770-749-0420
Practice Address - Fax:770-748-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty