Provider Demographics
NPI:1518228022
Name:NORTH GEORGIA HEALTH CARE GROUP LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA HEALTH CARE GROUP LLC
Other - Org Name:GEORGIA MEDICAL TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CAVACIUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-345-2000
Mailing Address - Street 1:557 RIVERSTONE PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5223
Mailing Address - Country:US
Mailing Address - Phone:770-345-2000
Mailing Address - Fax:770-345-4524
Practice Address - Street 1:557 RIVERSTONE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5223
Practice Address - Country:US
Practice Address - Phone:770-345-2000
Practice Address - Fax:770-345-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53772207P00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty