Provider Demographics
NPI:1831236728
Name:INFECTIOUS DISEASE SERVICES OF GEORGIA PC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE SERVICES OF GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-255-1069
Mailing Address - Street 1:11660 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4943
Mailing Address - Country:US
Mailing Address - Phone:770-255-1069
Mailing Address - Fax:770-255-1075
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-255-1069
Practice Address - Fax:770-255-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003233274AMedicaid