Provider Demographics
NPI:1720015993
Name:NORTHEAST GEORGIA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTHEAST GEORGIA MEDICAL CENTER, INC.
Other - Org Name:REHAB UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-219-3562
Mailing Address - Street 1:PO BOX 741891
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1891
Mailing Address - Country:US
Mailing Address - Phone:770-219-9000
Mailing Address - Fax:770-219-6694
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-9000
Practice Address - Fax:770-219-6694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST GEORGIA MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-26
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000888AMedicaid
GA=========OtherTIN
GA11T029Medicare PIN
GA=========OtherOTHER