Provider Demographics
NPI:1902407307
Name:ENDOCRINE SPECIALISTS OF GEORGIA, LLC
Entity Type:Organization
Organization Name:ENDOCRINE SPECIALISTS OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-382-0185
Mailing Address - Street 1:PO BOX 2016
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-1684
Mailing Address - Country:US
Mailing Address - Phone:770-382-0185
Mailing Address - Fax:770-382-0247
Practice Address - Street 1:40 FOX CHASE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2491
Practice Address - Country:US
Practice Address - Phone:770-382-0185
Practice Address - Fax:770-382-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty