Organization Name: | MEDICO FAMILIAR INC. |
NPI Number: | 1154582278 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHAH INAYAT (OWNER) |
Mailing Address: | 5345 Jimmy Carter Blvd Suite I Norcross |
State: | GA US |
Postal Code: | 300931524 |
Phone Number: | 7704097338 |
Fax Number: | 7704097339 |
NPI Enumeration Date: | 06/20/2008 |
NPI Last Update Date: | 06/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 047908 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |