Provider Demographics
NPI:1902028327
Name:THE MEDICAL CLINICS OF GEORGIA, LLC
Entity Type:Organization
Organization Name:THE MEDICAL CLINICS OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-258-1002
Mailing Address - Street 1:425 W.COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:BOWDON
Mailing Address - State:GA
Mailing Address - Zip Code:30108-1311
Mailing Address - Country:US
Mailing Address - Phone:770-258-1002
Mailing Address - Fax:770-258-1003
Practice Address - Street 1:425 W.COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-1311
Practice Address - Country:US
Practice Address - Phone:770-258-1002
Practice Address - Fax:770-258-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA040605261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health