Basic Information
| Provider Information | |||||||||
| NPI: | 1497827844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACES FERRY MEDICAL GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 250029 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043515262 | ||||||||
| FaxNumber: | 4043508873 | ||||||||
| Practice Location | |||||||||
| Address1: | 3193 HOWELL MILL RD | ||||||||
| Address2: | STE 223 PACES FERRY MEDICAL GROUP PC | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043515262 | ||||||||
| FaxNumber: | 4043508873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | ALVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4043515262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.