1750168829 NPI number — THE FAMILY HEALTH CENTERS OF GEORGIA, INC

Table of content: KATHY JEAN LESTRANGE PAC (NPI 1568448892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750168829 NPI number — THE FAMILY HEALTH CENTERS OF GEORGIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FAMILY HEALTH CENTERS OF GEORGIA, INC
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:
1750168829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
868 YORK AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30310-2750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-752-1400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6015 FELDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30349-3651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-752-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BROOKS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
404-752-1400

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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