Provider Demographics
NPI:1649727058
Name:PRACTICE MANAGEMENT RESOURCE GROUP LLC
Entity type:Organization
Organization Name:PRACTICE MANAGEMENT RESOURCE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-222-2803
Mailing Address - Street 1:10130 PERIMETER PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2447
Mailing Address - Country:US
Mailing Address - Phone:704-222-2805
Mailing Address - Fax:704-943-0547
Practice Address - Street 1:705 S WELDON ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3967
Practice Address - Country:US
Practice Address - Phone:704-222-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251K00000XAgenciesPublic Health or Welfare
No251X00000XAgenciesSupports Brokerage