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BLACKPOOL LLC NPI 1124361811


NPI Information

NPI: 1124361811
Provider Name: BLACKPOOL LLC

Doing Business As: GEORGIA MEDICAL CLINIC

Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Address:
4415 FRONT NINE DR STE 600
CUMMING, GA
ZIP 30041
Phone: (770) 744-7688
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BLACKPOOL LLC is an internal medicine in Cumming, GA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. BLACKPOOL LLC NPI is 1124361811. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Georgia Medical Clinic.

The provider's business location address is:

4415 FRONT NINE DR STE 600
CUMMING, GA
ZIP 30041-239
Phone: (770) 744-7688
Fax: (770) 406-1058

The provider's authorized official is Venkatappa Rangaraj .
The authorized official title is Owner and has the following contact phone number (513) 218-3468.

The enumeration date for this NPI number is 4/1/2013 and was last updated on 2/14/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal Medicine058633GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1003132617AMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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