Provider Demographics
NPI:1265666176
Name:GOVERNORS FAMIILY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:GOVERNORS FAMIILY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:TROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-975-9077
Mailing Address - Street 1:4900 IVEY RD NW
Mailing Address - Street 2:SUITE 1826
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4001
Mailing Address - Country:US
Mailing Address - Phone:770-975-9077
Mailing Address - Fax:770-790-4964
Practice Address - Street 1:4900 IVEY RD NW
Practice Address - Street 2:SUITE 1826
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4001
Practice Address - Country:US
Practice Address - Phone:770-975-9077
Practice Address - Fax:770-790-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty