Provider Demographics
NPI:1497827844
Name:PACES FERRY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:PACES FERRY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-351-5262
Mailing Address - Street 1:PO BOX 250029
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325
Mailing Address - Country:US
Mailing Address - Phone:404-351-5262
Mailing Address - Fax:404-350-8873
Practice Address - Street 1:3193 HOWELL MILL RD
Practice Address - Street 2:STE 223 PACES FERRY MEDICAL GROUP PC
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:404-351-5262
Practice Address - Fax:404-350-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3067Medicare PIN