Provider Demographics
NPI:1114041928
Name:NORTH CHATTAHOOCHEE FAMILY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:NORTH CHATTAHOOCHEE FAMILY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-497-1555
Mailing Address - Street 1:11459 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-3515
Mailing Address - Country:US
Mailing Address - Phone:770-497-1555
Mailing Address - Fax:770-497-9998
Practice Address - Street 1:11459 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3515
Practice Address - Country:US
Practice Address - Phone:770-497-1555
Practice Address - Fax:770-497-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty