Provider Demographics
NPI:1518108646
Name:MMG, LLC
Entity Type:Organization
Organization Name:MMG, LLC
Other - Org Name:DRS 4 DRS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-374-4377
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-0622
Mailing Address - Country:US
Mailing Address - Phone:866-374-4377
Mailing Address - Fax:877-359-9789
Practice Address - Street 1:207 COMMERCE CIR SW
Practice Address - Street 2:STE A
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6839
Practice Address - Country:US
Practice Address - Phone:866-374-4377
Practice Address - Fax:877-359-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty