Basic Information
| Provider Information | |||||||||
| NPI: | 1013497106 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 24 ON PHYSICIAN PARTNERS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 318 MAXWELL RD STE 500 | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300092064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707400895 | ||||||||
| FaxNumber: | 7707400896 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 S LAKE PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HOBART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463426638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199454580 | ||||||||
| FaxNumber: | 2199454581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2018 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | FULLER | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7707400895 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.