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EAGLES LANDING FAMILY PRACTICE LLC NPI 1710079850


NPI Information

NPI: 1710079850
Provider Name: EAGLES LANDING FAMILY PRACTICE, LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D2143042

Address:
649 JONESBORO ROAD
MCDONOUGH, GA
ZIP 30253
Phone: (678) 432-6161
Get Directions

EAGLES LANDING FAMILY PRACTICE, LLC is a family medicine in Mcdonough, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. EAGLES LANDING FAMILY PRACTICE, LLC NPI is 1710079850. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

649 JONESBORO ROAD
MCDONOUGH, GA
ZIP 30253
Phone: (678) 432-6161
Fax: (678) 432-3677

The provider's authorized official is Jeff Mitcham .
The authorized official title is Business Manager and has the following contact phone number (770) 914-0116.

The CLIA number assigned to this NPI record is 11D2143042 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/28/2006 and was last updated on 2/6/2020.


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
1207Q00000XFamily MedicineYes

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
1CC6012OTHERGEORGIARAILROAD MEDICARE
2061407OTHERGEORGIABC/BS OF GA GROUP

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

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