Premium Care Med Group Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

029068 Issued in GA

Legal business name

PREMIUM CARE MED GROUP INC

Practice address

3828 Salem Rd
Suite 200
Covington, GA 30016-4528

Phone

(404) 422-8719

NPI assigned

Jul 16, 2009

Organization subpart

No

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

Authorized official

Name

Ted M Pennel

Title

Ceo

Phone

(404) 422-8719

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247702400000",
    "number": "1295965986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3828 SALEM RD",
            "address_2": "SUITE 200",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3828 SALEM RD",
            "address_2": "SUITE 200",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164528",
            "telephone_number": "404-422-8719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM CARE MED GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-16",
        "last_updated": "2009-07-16",
        "status": "A",
        "authorized_official_last_name": "PENNEL",
        "authorized_official_first_name": "TED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-422-8719"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "029068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Covington, GA
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• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; 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.