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PREMISE HEALTH OF GEORGIA MEDICAL P.C. NPI 1437213709


NPI Information

NPI: 1437213709
Provider Name: PREMISE HEALTH OF GEORGIA MEDICAL, P.C.

Doing Business As: SOUTHWIRE FAMILY MEDICAL CENTER

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D0876169

Address:
1128 S PARK ST
CARROLLTON, GA
ZIP 30119
Phone: (770) 836-0870
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PREMISE HEALTH OF GEORGIA MEDICAL, P.C. is a family medicine in Carrollton, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PREMISE HEALTH OF GEORGIA MEDICAL, P.C. NPI is 1437213709. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Southwire Family Medical Center.

The provider's business location address is:

1128 S PARK ST
CARROLLTON, GA
ZIP 30119-450
Phone: (770) 836-0870
Fax: (770) 836-1837

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 11D0876169 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/21/2006 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
1207Q00000XFamily MedicineYes

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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