Provider Demographics
NPI:1760531206
Name:HOMETOWN MEDICAL GROUP
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-734-2878
Mailing Address - Street 1:194 ALLGOOD ST
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-1341
Mailing Address - Country:US
Mailing Address - Phone:706-734-2878
Mailing Address - Fax:706-734-2877
Practice Address - Street 1:194 ALLGOOD ST
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1341
Practice Address - Country:US
Practice Address - Phone:706-734-2878
Practice Address - Fax:706-734-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GA=========OtherTAX ID