NORTHEAST GEORGIA PHYSICIANS GROUP INC. NPI 1104009059

NPI Information

  • NPI: 1104009059
  • Provider Name: NORTHEAST GEORGIA PHYSICIANS GROUP, INC.
  • Classification: Family Medicine - 207QS0010X
  • Specialization: Sports Medicine
  • Entity Type: Organization
  • Address: 115 TOWNE CENTER PKWY
    SUITE 113
    HOSCHTON, GA
    ZIP 30548
  • Phone: (706) 658-2452

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NPI Details

NORTHEAST GEORGIA PHYSICIANS GROUP, INC. is a sports medicine family medicine in Hoschton, GA. The provider is a family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. NORTHEAST GEORGIA PHYSICIANS GROUP, INC. NPI is 1104009059. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

115 TOWNE CENTER PKWY
SUITE 113
HOSCHTON, GA
ZIP 30548-213
Phone: (706) 658-2452
Fax: (706) 658-2462

The provider's authorized official is J. Shannon Glover .
The authorized official title is Exec. Director Managed Care and has the following contact phone number (770) 219-7826.

The enumeration date for this NPI number is 12/14/2007 and was last updated on 4/15/2011.

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
1207QS0010XFamily MedicineSports Medicine60363GEORGIAYes

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
1574554373AMEDICAIDGEORGIA

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: 11/21/2025

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