Provider Demographics
NPI:1053703595
Name:HORIZON MEDICAL GROUP LLC
Entity type:Organization
Organization Name:HORIZON MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEDION
Authorized Official - Middle Name:
Authorized Official - Last Name:ATNAFU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-650-4100
Mailing Address - Street 1:7845 OAKWOOD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4280
Mailing Address - Country:US
Mailing Address - Phone:410-650-4100
Mailing Address - Fax:877-648-1188
Practice Address - Street 1:7845 OAKWOOD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4280
Practice Address - Country:US
Practice Address - Phone:410-650-4100
Practice Address - Fax:877-648-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 208M00000X
MDD0062148207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408456000Medicaid
MD408456000Medicaid
MDM419Medicare PIN