Basic Information
| Provider Information | |||||||||
| NPI: | 1902407307 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENDOCRINE SPECIALISTS OF GEORGIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2016 | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301201684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703820185 | ||||||||
| FaxNumber: | 7703820247 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 FOX CHASE | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301202491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703820185 | ||||||||
| FaxNumber: | 7703820247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | PUENTES | ||||||||
| AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7703820185 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.