Provider Demographics
NPI:1598938300
Name:PREMIER MD GROUP INC.
Entity Type:Organization
Organization Name:PREMIER MD GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIOSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-925-7001
Mailing Address - Street 1:620 HILLCREST RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1709
Mailing Address - Country:US
Mailing Address - Phone:770-925-7001
Mailing Address - Fax:770-925-7099
Practice Address - Street 1:620 HILLCREST RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1709
Practice Address - Country:US
Practice Address - Phone:770-925-7001
Practice Address - Fax:770-925-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty