Provider Demographics
NPI:1740322858
Name:NEXTCARE GEORGIA, LLC
Entity type:Organization
Organization Name:NEXTCARE GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REIMBURSEMENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-924-8382
Mailing Address - Street 1:2550 N THUNDERBIRD CIRCLE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1215
Mailing Address - Country:US
Mailing Address - Phone:480-924-8382
Mailing Address - Fax:480-776-1605
Practice Address - Street 1:1220 CAROLINE ST NE
Practice Address - Street 2:SUITE 230
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2749
Practice Address - Country:US
Practice Address - Phone:800-849-5609
Practice Address - Fax:910-868-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7968Medicare PIN