Provider Demographics
NPI:1629025143
Name:APOGEE MEDICAL GROUP GEORGIA
Entity Type:Organization
Organization Name:APOGEE MEDICAL GROUP GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-778-3600
Mailing Address - Street 1:PO BOX 25016
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-1016
Mailing Address - Country:US
Mailing Address - Phone:972-269-1897
Mailing Address - Fax:469-249-1170
Practice Address - Street 1:705 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3818
Practice Address - Country:US
Practice Address - Phone:770-836-9667
Practice Address - Fax:770-838-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF4338OtherRR MEDICARE
GAGRP7730Medicare PIN