Provider Demographics
NPI:1457646770
Name:FAMILY TOTAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:FAMILY TOTAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-367-5525
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0627
Mailing Address - Country:US
Mailing Address - Phone:912-537-2564
Mailing Address - Fax:912-538-9391
Practice Address - Street 1:509 JACKSON ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4720
Practice Address - Country:US
Practice Address - Phone:912-537-2564
Practice Address - Fax:912-538-9391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTAMAHA MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001572111N00000X
GA47233207R00000X
GA122840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty