Provider Demographics
NPI:1205855988
Name:FAMILY HEALTH CARE CENTER, PC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE CENTER, PC
Other - Org Name:FAMILY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-489-4090
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0957
Mailing Address - Country:US
Mailing Address - Phone:912-489-4090
Mailing Address - Fax:912-764-5028
Practice Address - Street 1:23702 HIGHWAY 80 EAST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-489-4090
Practice Address - Fax:912-764-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004250261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center