Provider Demographics
NPI:1689855009
Name:PHYSICIANS IMMEDIATE MED OF DAWSONVILLE
Entity Type:Organization
Organization Name:PHYSICIANS IMMEDIATE MED OF DAWSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISHAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MERSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-216-6000
Mailing Address - Street 1:7320 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-4731
Mailing Address - Country:US
Mailing Address - Phone:706-216-6000
Mailing Address - Fax:
Practice Address - Street 1:91 NORDSON OVERLOOK
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-216-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center