PREMISE HEALTH OF GEORGIA MEDICAL P.C. NPI 1306196027

NPI Information

PREMISE HEALTH OF GEORGIA MEDICAL, P.C. is a primary care clinic center in Gainesville, GA. PREMISE HEALTH OF GEORGIA MEDICAL, P.C. NPI is 1306196027. The provider is registered as an organization entity type.
The provider Is Doing Business As Fieldale Farms Family Medical Center.

The provider's business location address is:

584 LANIER PARK DR
GAINESVILLE, GA
ZIP 30501-000
Phone: (770) 532-5685
Fax: (770) 532-8515

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 11D2049219 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/11/2012 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:

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