Basic Information
| Provider Information | |||||||||
| NPI: | 1174024376 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORT OGLETHORPE EMERGENCY PHYSICIANS GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 722756 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730709089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052963630 | ||||||||
| FaxNumber: | 4053419217 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 GROSS CRESCENT CIR | ||||||||
| Address2: | |||||||||
| City: | FORT OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375340952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2018 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | BOYKIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4045008147 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.