NPIMap

Organization Active NPI

Northeast Georgia Medical Center, Inc

Doing business as Northeast Georgia Medical Center Pharmacy-Braselton

  • Community/Retail Pharmacy
  • Braselton, GA
National Provider Identifier
1992169197
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE010289 Issued in GA
Legal business name
NORTHEAST GEORGIA MEDICAL CENTER, INC
Doing business as
Northeast Georgia Medical Center Pharmacy-Braselton
Practice address
1515 River PL Ste 180
Braselton, GA 30517-5603
Phone
(770) 848-6337
Fax
(770) 848-6338
NPI assigned
Apr 13, 2016
Last updated
Apr 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Authorized official

Name
Brian D Steines
Title
Cfo
Phone
(770) 219-3562

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE010289 GA Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1515 River PL Ste 180
Braselton, GA 30517-5603

Mailing address

PO Box 741891
Atlanta, GA 30374-1891
Phone (770) 848-6337

Other identifiers 2

IdentifierTypeStateIssuer
003177713AMedicaidGA
2159511OtherPK

Other names 1

  • Northeast Georgia Medical Center Pharmacy-Braselton Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northeast Georgia Health Services11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1515 River Pl
Ste 180
Braselton, GA 30517
Phone (770) 848-6337

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1992169197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741891",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303741891",
            "telephone_number": "770-848-6337",
            "fax_number": "770-848-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 RIVER PL STE 180",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305175603",
            "telephone_number": "770-848-6337",
            "fax_number": "770-848-6338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "STEINES",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-219-3562"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010289",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003177713A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2159511",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Georgia Medical Center Pharmacy-Braselton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 22, 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.