Provider Demographics
NPI:1508192451
Name:HEART OF GEORGIA PHYSICIANS, LLC
Entity Type:Organization
Organization Name:HEART OF GEORGIA PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLES
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:478-272-4544
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1470
Mailing Address - Country:US
Mailing Address - Phone:478-272-4544
Mailing Address - Fax:478-275-1306
Practice Address - Street 1:292 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-8002
Practice Address - Country:US
Practice Address - Phone:478-272-4544
Practice Address - Fax:478-275-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty