Provider Demographics
NPI:1295992022
Name:MURRAY INTERNAL MEDICINE, PC
Entity type:Organization
Organization Name:MURRAY INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-695-1488
Mailing Address - Street 1:106 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-2070
Mailing Address - Country:US
Mailing Address - Phone:706-695-1488
Mailing Address - Fax:706-422-9586
Practice Address - Street 1:106 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2070
Practice Address - Country:US
Practice Address - Phone:706-695-1488
Practice Address - Fax:706-422-9586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00543837CMedicaid
GA00543837CMedicaid
GA11BDNXVMedicare PIN