Provider Demographics
NPI:1710389085
Name:PHYSICIANS PRACTICE GROUP
Entity Type:Organization
Organization Name:PHYSICIANS PRACTICE GROUP
Other - Org Name:GEORGIA REGENTS MEDICAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE VP
Authorized Official - Phone:706-721-6076
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:SUITE AF-2033
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-6016
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:SUITE AF-2033
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-6016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital