| Organization Name: | MENLO FAMILY MEDICINE, PC |
| NPI Number: | 1154719623 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CONNIE WITT (OWNER) |
| Mailing Address: | 2968 Hwy 337 Menlo |
| State: | GA US |
| Postal Code: | 307310147 |
| Phone Number: | 7068621717 |
| Fax Number: | 7068621718 |
| NPI Enumeration Date: | 01/06/2015 |
| NPI Last Update Date: | 01/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN045044 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |