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FAVOR FAMILY MEDICAL PRACTICE LLC NPI 1336762913


NPI Information

NPI: 1336762913
Provider Name: FAVOR FAMILY MEDICAL PRACTICE LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D2217628

Address:
103 MOUNTAIN BROOK DR STE 100
CANTON, GA
ZIP 30115
Phone: (678) 880-8893
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FAVOR FAMILY MEDICAL PRACTICE LLC is a family medicine in Canton, 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. FAVOR FAMILY MEDICAL PRACTICE LLC NPI is 1336762913. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

103 MOUNTAIN BROOK DR STE 100
CANTON, GA
ZIP 30115-078
Phone: (678) 880-8893
Fax: (678) 880-8589

The provider's authorized official is Eunice Momeh .
The authorized official title is Ceo and has the following contact phone number (678) 880-8893.

The CLIA number assigned to this NPI record is 11D2217628 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/18/2020 and was last updated on 1/21/2021.


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
113911414MEDICAIDGEORGIA

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.