Provider Demographics
NPI:1619996907
Name:NORTH GEORGIA INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:NORTH GEORGIA INTERNAL MEDICINE, PC
Other - Org Name:NORTH GEORGIA OSTEOPOROSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-494-4450
Mailing Address - Street 1:1192 BUCKHEAD XING
Mailing Address - Street 2:SUITE E
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4254
Mailing Address - Country:US
Mailing Address - Phone:678-494-4450
Mailing Address - Fax:678-494-6265
Practice Address - Street 1:1192 BUCKHEAD XING
Practice Address - Street 2:SUITE E
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4254
Practice Address - Country:US
Practice Address - Phone:678-494-4450
Practice Address - Fax:678-494-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4557Medicare PIN