Organization Name: | BLAIRSVILLE FAMILY PRACTICE, PC |
NPI Number: | 1316205073 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES LANIER HEATON (PRESIDENT) |
Mailing Address: | 123 Weaver Rd Suite B Blairsville |
State: | GA US |
Postal Code: | 305123155 |
Phone Number: | 7067455556 |
Fax Number: | 7067451822 |
NPI Enumeration Date: | 05/01/2012 |
NPI Last Update Date: | 05/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 31257 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |