Provider Demographics
NPI:1053485037
Name:STONE MOUNTAIN FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:STONE MOUNTAIN FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-469-7000
Mailing Address - Street 1:1805 PARKE PLAZA CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3498
Mailing Address - Country:US
Mailing Address - Phone:770-469-7000
Mailing Address - Fax:770-879-0436
Practice Address - Street 1:1805 PARKE PLAZA CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3498
Practice Address - Country:US
Practice Address - Phone:770-469-7000
Practice Address - Fax:770-879-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP690Medicare ID - Type UnspecifiedGROUP NUMBER