Provider Demographics
NPI:1598330714
Name:NORTHWEST GEORGIA HEALTHCARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:NORTHWEST GEORGIA HEALTHCARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:NALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-672-8470
Mailing Address - Street 1:2950 CHEROKEE ST NW STE 900
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6505
Mailing Address - Country:US
Mailing Address - Phone:470-221-0216
Mailing Address - Fax:404-393-5586
Practice Address - Street 1:189 PROFESSIONAL CT SE STE 400
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7056
Practice Address - Country:US
Practice Address - Phone:470-221-0216
Practice Address - Fax:404-393-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service