Provider Demographics
NPI:1477723526
Name:ISHWAR FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:ISHWAR FAMILY MEDICINE LLC
Other - Org Name:ISHWAR FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARANDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-235-1037
Mailing Address - Street 1:6045 SOUTHARD TRACE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-888-0717
Mailing Address - Fax:770-888-0763
Practice Address - Street 1:6045 SOUTHARD TRACE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-888-0717
Practice Address - Fax:770-888-0763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
GA058617261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA221611733DMedicaid
GA221611733DMedicaid