Provider Demographics
NPI:1669668547
Name:THE MEDICAL GROUP OF SAINT JOSEPH'S, LLC
Entity Type:Organization
Organization Name:THE MEDICAL GROUP OF SAINT JOSEPH'S, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-250-6409
Mailing Address - Street 1:5669 PEACHTREE DUNWOODY RD. NE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1736
Mailing Address - Country:US
Mailing Address - Phone:404-250-6400
Mailing Address - Fax:404-250-6405
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD. NE
Practice Address - Street 2:SUITE 315
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1736
Practice Address - Country:US
Practice Address - Phone:404-250-6400
Practice Address - Fax:404-250-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034834207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA135306594AMedicaid
GA135306594AMedicaid