Organization Name: | DOUGLAS COUNTY FAMILY PRACTICE, P.C. |
NPI Number: | 1013918671 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARIAM GEORGE (FAMILY PRACTICE PHYSICIAN) |
Mailing Address: | 3872 Highway 5 Douglasville |
State: | GA US |
Postal Code: | 301353366 |
Phone Number: | 7709495535 |
Fax Number: | 7709499022 |
NPI Enumeration Date: | 08/04/2005 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 023734 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |