1386763514 NPI number — FAMILY PRACTICE CENTER, P.C.

Table of content: (NPI 1386763514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386763514 NPI number — FAMILY PRACTICE CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PRACTICE CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386763514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
993 JOHNSON FERRY RD NE # F
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-256-1727
Provider Business Mailing Address Fax Number:
404-256-0192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
993 JOHNSON FERRY RD NE BLDG F
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-256-1727
Provider Business Practice Location Address Fax Number:
404-252-3591
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARRETTE
Authorized Official First Name:
FELICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
404-256-1727

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  BL02-00353 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1871027870 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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