Provider Demographics
NPI:1477738334
Name:BIBB FAMILY PRACTICE ASSO PC
Entity Type:Organization
Organization Name:BIBB FAMILY PRACTICE ASSO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SABINA
Authorized Official - Middle Name:BREW
Authorized Official - Last Name:AMPORFUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-259-3439
Mailing Address - Street 1:721 RIVERSIDE DR LANE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2658
Mailing Address - Country:US
Mailing Address - Phone:478-259-3439
Mailing Address - Fax:478-254-2733
Practice Address - Street 1:721 RIVERSIDE DR LANE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2658
Practice Address - Country:US
Practice Address - Phone:478-259-3439
Practice Address - Fax:478-254-2733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIBB FAMILY PRACTICE ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
030940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty