Provider Demographics
NPI:1649536749
Name:NG MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:NG MEDICAL GROUP, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:URRUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-771-5050
Mailing Address - Street 1:4355 BROWNS BRIDGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-4554
Mailing Address - Country:US
Mailing Address - Phone:770-771-5050
Mailing Address - Fax:770-771-5051
Practice Address - Street 1:4355 BROWNS BRIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-4554
Practice Address - Country:US
Practice Address - Phone:770-771-5050
Practice Address - Fax:770-771-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G709404OtherPTAN MEDICARE
GA11D2043142OtherCLIA