Provider Demographics
NPI:1003200015
Name:MID GEORGIA TOTAL CARE LLC
Entity type:Organization
Organization Name:MID GEORGIA TOTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERSCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-344-2550
Mailing Address - Street 1:1111 GRIFFIN AVE
Mailing Address - Street 2:STE 1B
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-9104
Mailing Address - Country:US
Mailing Address - Phone:478-374-8998
Mailing Address - Fax:478-374-8525
Practice Address - Street 1:1111 GRIFFIN AVE
Practice Address - Street 2:STE 1B
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9104
Practice Address - Country:US
Practice Address - Phone:478-374-8998
Practice Address - Fax:478-374-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty