Provider Demographics
NPI:1194838706
Name:FAMILY CARE NORTH, PC
Entity Type:Organization
Organization Name:FAMILY CARE NORTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-494-1454
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0846
Mailing Address - Country:US
Mailing Address - Phone:706-494-1454
Mailing Address - Fax:706-494-1455
Practice Address - Street 1:1921 WHITTLESEY RD
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9213
Practice Address - Country:US
Practice Address - Phone:706-494-1454
Practice Address - Fax:706-494-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4711Medicare PIN