Provider Demographics
NPI:1447618707
Name:CONCIERGE MEDICAL MGMT GROUP
Entity Type:Organization
Organization Name:CONCIERGE MEDICAL MGMT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-500-9568
Mailing Address - Street 1:760 OLD ROSWELL RD STE 117
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8685
Mailing Address - Country:US
Mailing Address - Phone:800-704-8875
Mailing Address - Fax:888-840-1265
Practice Address - Street 1:760 OLD ROSWELL RD STE 117
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:800-704-8875
Practice Address - Fax:888-816-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site