Provider Demographics
NPI:1194179861
Name:A HUMBLING SPIRIT FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:A HUMBLING SPIRIT FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON-BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-358-0443
Mailing Address - Street 1:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081-2198
Mailing Address - Country:US
Mailing Address - Phone:404-358-0443
Mailing Address - Fax:678-348-7577
Practice Address - Street 1:2412 HORSESHOE BEND RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4412
Practice Address - Country:US
Practice Address - Phone:404-358-0443
Practice Address - Fax:678-348-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08697305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service