Provider Demographics
NPI:1629586698
Name:NORTH GEORGIA PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:NORTH GEORGIA PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMBOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-888-8292
Mailing Address - Street 1:6030 BETHELVIEW RD STE 502
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8025
Mailing Address - Country:US
Mailing Address - Phone:770-888-8292
Mailing Address - Fax:770-888-9858
Practice Address - Street 1:6030 BETHELVIEW RD STE 502
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8025
Practice Address - Country:US
Practice Address - Phone:770-888-8292
Practice Address - Fax:770-888-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty