Organization Name: | NORTHWEST GEORGIA FAMILY PRACTICE CENTER, PC |
NPI Number: | 1689765083 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HERMAN E. SPIVEY (OWNER) |
Mailing Address: | 68 Stockade Rd Summerville |
State: | GA US |
Postal Code: | 307471900 |
Phone Number: | 7068575402 |
Fax Number: | 7068571800 |
NPI Enumeration Date: | 09/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |