Provider Demographics
NPI:1811321011
Name:NORTHEAST GA MIDLEVEL SERVICES
Entity type:Organization
Organization Name:NORTHEAST GA MIDLEVEL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:706-338-3898
Mailing Address - Street 1:43031 PARKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:BABCOCK RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:33982-5065
Mailing Address - Country:US
Mailing Address - Phone:706-338-3898
Mailing Address - Fax:
Practice Address - Street 1:43031 PARKSIDE CT
Practice Address - Street 2:
Practice Address - City:BABCOCK RANCH
Practice Address - State:FL
Practice Address - Zip Code:33982-5065
Practice Address - Country:US
Practice Address - Phone:706-338-3898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-25
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4789363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty