Provider Demographics
NPI:1336651702
Name:CLINICA FAMILIAR Y PRENATAL
Entity Type:Organization
Organization Name:CLINICA FAMILIAR Y PRENATAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RCS
Authorized Official - Phone:678-755-5334
Mailing Address - Street 1:155 MEDICAL WAY STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4940
Mailing Address - Country:US
Mailing Address - Phone:678-755-5334
Mailing Address - Fax:404-529-4430
Practice Address - Street 1:155 MEDICAL WAY STE B
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4940
Practice Address - Country:US
Practice Address - Phone:678-755-5334
Practice Address - Fax:404-529-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN120872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty