Provider Demographics
NPI:1689736407
Name:MED GLOBE, P.C.
Entity Type:Organization
Organization Name:MED GLOBE, P.C.
Other - Org Name:MED GLOBE, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-933-9333
Mailing Address - Street 1:1686 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3621
Mailing Address - Country:US
Mailing Address - Phone:770-933-9333
Mailing Address - Fax:770-579-9331
Practice Address - Street 1:1686 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3621
Practice Address - Country:US
Practice Address - Phone:770-933-9333
Practice Address - Fax:770-579-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000821675AMedicaid
GA11BDQDLMedicare PIN
GA000821675AMedicaid