Provider Demographics
NPI:1124044292
Name:FAMILY HEALTH CENTER OF ADEL, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF ADEL, INC.
Other - Org Name:FAMILY HEALTH CENTER OF ADEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBERDHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-896-1672
Mailing Address - Street 1:406 N PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-2076
Mailing Address - Country:US
Mailing Address - Phone:229-896-1672
Mailing Address - Fax:229-896-1676
Practice Address - Street 1:406 N PARRISH AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2076
Practice Address - Country:US
Practice Address - Phone:229-896-1672
Practice Address - Fax:229-896-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA934774OtherBLUE CROSS BLUE SHIELD
GAGRP7806Medicare PIN