NPIMap

Organization Active NPI

Northeast Georgia Physicians Group, Inc.

  • Allergy Physician
  • Braselton, GA
National Provider Identifier
1134749211
Registry record updated Apr 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
Legal business name
NORTHEAST GEORGIA PHYSICIANS GROUP, INC.
Practice address
1515 River PL Ste 380
Braselton, GA 30517-5605
Phone
(770) 848-9345
NPI assigned
Apr 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shelby Ann Dodd
Title
Executive Director Physician Servic
Phone
(770) 219-8453

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207KA0200X Primary

Addresses

Primary practice location

1515 River PL Ste 380
Braselton, GA 30517-5605

Mailing address

1515 River PL Ste 380
Braselton, GA 30517-5605
Phone (770) 848-9345

National Provider Directory

National Provider Directory
Tax ID family
Northeast Georgia Primary5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1515 River Pl
Ste 380
Braselton, GA 30517
Phone (770) 848-9345

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1134749211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 RIVER PL STE 380",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305175605",
            "telephone_number": "770-848-9345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 RIVER PL STE 380",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305175605",
            "telephone_number": "770-848-9345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA PHYSICIANS GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "DODD",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR PHYSICIAN SERVIC",
        "authorized_official_telephone_number": "770-219-8453"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Braselton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.