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PREMISE HEALTH OF GEORGIA MEDICAL P.C. NPI 1306511381


NPI Information

NPI: 1306511381
Provider Name: PREMISE HEALTH OF GEORGIA MEDICAL, P.C.

Doing Business As: WALTON EMC - MONROE

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 11D2082378

Address:
501 MOUNT VERNON RD
MONROE, GA
ZIP 30655
Phone: (770) 267-2511
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PREMISE HEALTH OF GEORGIA MEDICAL, P.C. is a multi-specialty clinic center in Monroe, GA. PREMISE HEALTH OF GEORGIA MEDICAL, P.C. NPI is 1306511381. The provider is registered as an organization entity type.
The provider Is Doing Business As Walton Emc - Monroe.

The provider's business location address is:

501 MOUNT VERNON RD
MONROE, GA
ZIP 30655-028
Phone: (770) 267-2511
Fax: (978) 528-1330

The provider's authorized official is Jon Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 11D2082378 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 8/12/2021 and was last updated on 8/24/2022.


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
1261QM1300XClinic/CenterMulti-SpecialtyYes

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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