Basic Information
Provider Information
NPI: 1679631709
EntityType: 2
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OrganizationName: GEORGIA INTERNAL MEDICINE CARE ASSOCIATES
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Mailing Information
Address1: PO BOX 26040
Address2:  
City: MACON
State: GA
PostalCode: 312216040
CountryCode: US
TelephoneNumber: 4784751299
FaxNumber: 4784057928
Practice Location
Address1: 5900 HILLANDALE DR
Address2: SUITE 230
City: LITHONIA
State: GA
PostalCode: 300583802
CountryCode: US
TelephoneNumber: 4784751299
FaxNumber: 4784057928
Other Information
ProviderEnumerationDate: 12/04/2006
LastUpdateDate: 01/10/2012
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AuthorizedOfficialLastName: WHITEHEAD
AuthorizedOfficialFirstName: EDDIE
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AuthorizedOfficialTitleorPosition: DOCTOR
AuthorizedOfficialTelephone: 4784751299
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X32087GAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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