Provider Demographics
NPI:1114970258
Name:FAMILY CARE GROUP PC
Entity Type:Organization
Organization Name:FAMILY CARE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-377-3475
Mailing Address - Street 1:PO BOX 102906
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2906
Mailing Address - Country:US
Mailing Address - Phone:901-377-3475
Mailing Address - Fax:901-377-8068
Practice Address - Street 1:6555 STAGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2810
Practice Address - Country:US
Practice Address - Phone:901-377-3475
Practice Address - Fax:901-377-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN31671970OtherBLUE CROSS GROUP PROVIDER
TN31671970OtherBLUE CROSS GROUP PROVIDER
TN31671970OtherBLUE CROSS GROUP PROVIDER