Provider Demographics
NPI:1790822583
Name:JOHNS CREEK PRIMARY CARE PHYSICIANS LLC
Entity Type:Organization
Organization Name:JOHNS CREEK PRIMARY CARE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LH MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-957-1910
Mailing Address - Street 1:4365 JOHNS CREEK PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-957-1910
Mailing Address - Fax:678-957-1911
Practice Address - Street 1:4365 JOHNS CREEK PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-957-1910
Practice Address - Fax:678-957-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6354OtherMEDICARE PTAN