FAMILY PRACTICE HEALTHCARE CLINIC/ URGENT CARE NPI 1689802597

NPI Information

NPI: 1689802597
Provider Name: FAMILY PRACTICE HEALTHCARE CLINIC/ URGENT CARE
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
10 NORTH 3RD AVE
MCRAE, GA
ZIP 31055
Phone: (229) 868-2831
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FAMILY PRACTICE HEALTHCARE CLINIC/ URGENT CARE is a primary care clinic center in Mcrae, GA. FAMILY PRACTICE HEALTHCARE CLINIC/ URGENT CARE NPI is 1689802597. The provider is registered as an organization entity type.

The provider's business location address is:

10 NORTH 3RD AVE
MCRAE, GA
ZIP 31055-941
Phone: (229) 868-2831
Fax: (229) 520-3068

The provider's authorized official is Edmund Matt Wright .
The authorized official title is Md and has the following contact phone number (229) 868-2831.

The enumeration date for this NPI number is 6/30/2009 and was last updated on 3/28/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	RN115997	GEORGIA	No
2	261QU0200X	Clinic/Center	Urgent Care	RN115997	GEORGIA	No
3	261QU0200X	Clinic/Center	Urgent Care	037111	GEORGIA	No
4	261QP2300X	Clinic/Center	Primary Care	037111	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	RN115997	OTHER	GEORGIA	LICENSE NUMBER
2	202G086558	MEDICARE PIN	GEORGIA
3	000539283J	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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