Provider Demographics
NPI:1376665463
Name:FAMILY CARE CENTERS TRUST
Entity Type:Organization
Organization Name:FAMILY CARE CENTERS TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-501-4272
Mailing Address - Street 1:PO BOX 1024450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-0001
Mailing Address - Country:US
Mailing Address - Phone:404-501-4272
Mailing Address - Fax:
Practice Address - Street 1:1045 SYCAMORE DR
Practice Address - Street 2:ADMINSTRATION
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1645
Practice Address - Country:US
Practice Address - Phone:404-501-4272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty