FAMILY FIRST HEALTHCARE OF NORTHEAST GEORGIA NPI 1720300387

NPI Information

NPI: 1720300387
Provider Name: FAMILY FIRST HEALTHCARE OF NORTHEAST GEORGIA
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 11D2085179

Address:
11973 AUGUSTA RD
LAVONIA, GA
ZIP 30553
Phone: (706) 356-8181
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FAMILY FIRST HEALTHCARE OF NORTHEAST GEORGIA is a family nurse practitioner in Lavonia, GA. FAMILY FIRST HEALTHCARE OF NORTHEAST GEORGIA NPI is 1720300387. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11973 AUGUSTA RD
LAVONIA, GA
ZIP 30553-283
Phone: (706) 356-8181
Fax: (706) 356-8081

The provider's authorized official is Nicole Ford .
The authorized official title is Office Manager and has the following contact phone number (706) 356-8181.

The CLIA number assigned to this NPI record is 11D2085179 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/24/2010 and was last updated on 6/28/2010.

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	363LA2100X	Nurse Practitioner	Acute Care	RN144697NP	GEORGIA	No
2	363LC0200X	Nurse Practitioner	Critical Care Medicine	RN144697NP	GEORGIA	No
3	363LP2300X	Nurse Practitioner	Primary Care	RN144697NP	GEORGIA	No
4	363LF0000X	Nurse Practitioner	Family	RN144697NP	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
1	GRP707	MEDICARE PIN	GEORGIA
2	132982	MEDICAID	SOUTH CAROLINA
3	85001253G	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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