Basic Information
| Provider Information | |||||||||
| NPI: | 1699230656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GA PHYSICIAN SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HEALTH PARK DR | ||||||||
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| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153727600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | TRION | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307531125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067347302 | ||||||||
| FaxNumber: | 7067347356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2019 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 4695498616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.