Provider Demographics
NPI:1013184407
Name:MIDDLE GEORGIA FAMILY MEDICINE,LLC
Entity Type:Organization
Organization Name:MIDDLE GEORGIA FAMILY MEDICINE,LLC
Other - Org Name:MIDDLE GEORGIA FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:DODGE COUNTY HOSPITAL CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-448-4050
Mailing Address - Street 1:829 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6757
Mailing Address - Country:US
Mailing Address - Phone:478-374-9309
Mailing Address - Fax:478-374-3310
Practice Address - Street 1:829 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6757
Practice Address - Country:US
Practice Address - Phone:478-374-9309
Practice Address - Fax:478-374-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty