Provider Demographics
NPI:1407905540
Name:FAMILY PRACTICE ASSOCIATES OF ATLANTA
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF ATLANTA
Other - Org Name:OCCUPATIONAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SEYFRIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-454-0091
Mailing Address - Street 1:1776 OLD SPRING HOUSE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6225
Mailing Address - Country:US
Mailing Address - Phone:770-454-0091
Mailing Address - Fax:
Practice Address - Street 1:1776 OLD SPRING HOUSE LN
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6225
Practice Address - Country:US
Practice Address - Phone:770-454-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAS3027390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC78783Medicare UPIN
GAD42369Medicare UPIN
GAD45630Medicare UPIN
GAGRP4295Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER