Provider Demographics
NPI:1407010689
Name:SCREVEN COUNTY FAMILY MEDICINE
Entity Type:Organization
Organization Name:SCREVEN COUNTY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:DEGNON
Authorized Official - Last Name:MCFARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-564-9285
Mailing Address - Street 1:PO BOX 1938
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467
Mailing Address - Country:US
Mailing Address - Phone:912-564-9285
Mailing Address - Fax:912-564-2174
Practice Address - Street 1:215 MIMS ROAD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467
Practice Address - Country:US
Practice Address - Phone:912-564-9285
Practice Address - Fax:912-564-2174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCREVEN COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA251294760DMedicaid
GAI58674Medicare UPIN