Provider Demographics
NPI:1558562181
Name:NORTH GEORGIA PRIMARY CARE PC
Entity Type:Organization
Organization Name:NORTH GEORGIA PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CH-CBS
Authorized Official - Phone:706-633-4132
Mailing Address - Street 1:14 SAMMY MCGHEE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7723
Mailing Address - Country:US
Mailing Address - Phone:706-253-3842
Mailing Address - Fax:706-253-3842
Practice Address - Street 1:14 SAMMY MCGHEE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7723
Practice Address - Country:US
Practice Address - Phone:706-253-3842
Practice Address - Fax:706-253-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032586207R00000X
GA048322207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000412618IMedicaid
GA762424450AMedicaid
GAGRP4247OtherMEDICARE GROUP FOR NORTH
GA46BBBJGMedicare ID - Type UnspecifiedJASON A BERNER MD
GAGRP4247OtherMEDICARE GROUP FOR NORTH
GAH89461Medicare UPIN
GA11BDFFWMedicare ID - Type UnspecifiedBRYAN D HOOKER MD