Organization Name: | FAMILY PRACTICE OF HABERSHAM PC |
NPI Number: | 1124154794 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BEVERLY C CARTER (MANAGER) |
Mailing Address: | 590 Historic Hwy 441 N Demorest |
State: | GA US |
Postal Code: | 305351779 |
Phone Number: | 7067545511 |
Fax Number: | 7067545577 |
NPI Enumeration Date: | 02/26/2007 |
NPI Last Update Date: | 12/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 032741 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |