Provider Demographics
NPI:1891992889
Name:G & G INTERNATIONAL LLC
Entity Type:Organization
Organization Name:G & G INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSW
Authorized Official - Phone:440-354-9775
Mailing Address - Street 1:2165 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077
Mailing Address - Country:US
Mailing Address - Phone:440-354-9775
Mailing Address - Fax:440-354-9778
Practice Address - Street 1:2165 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-354-9775
Practice Address - Fax:440-354-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3612301Medicare PIN