Provider Demographics
NPI:1518090836
Name:NORTHEAST GEORGIA HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA HEALTH SERVICES
Other - Org Name:EMPLOYEE PHARMACY
Other - Org Type:Other Name
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:PO BOX 741891
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1891
Mailing Address - Country:US
Mailing Address - Phone:770-531-3800
Mailing Address - Fax:770-538-7062
Practice Address - Street 1:825 JESSE JEWELL PARKWAY SUITE D
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:678-897-6337
Practice Address - Fax:678-897-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0077383336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN