Provider Demographics
NPI:1336692599
Name:FAMILY PRACTICE ASSOCIATES OF TIFTAREA
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF TIFTAREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:BBA-HM
Authorized Official - Phone:229-391-3300
Mailing Address - Street 1:612 LOVE AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-391-3300
Mailing Address - Fax:229-388-1948
Practice Address - Street 1:612 LOVE AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-391-3300
Practice Address - Fax:229-388-1948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty