Provider Demographics
NPI:1235470451
Name:FAMILY MEDICAL CENTER URGENT CARE
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-458-4842
Mailing Address - Street 1:2855 CANDLER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1415
Mailing Address - Country:US
Mailing Address - Phone:404-458-4842
Mailing Address - Fax:
Practice Address - Street 1:2855 CANDLER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034
Practice Address - Country:US
Practice Address - Phone:404-458-4842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty