Provider Demographics
NPI:1508017542
Name:HEALTHY FAMILY PC
Entity Type:Organization
Organization Name:HEALTHY FAMILY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-265-0339
Mailing Address - Street 1:PO BOX 22937
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31403-2937
Mailing Address - Country:US
Mailing Address - Phone:912-234-8933
Mailing Address - Fax:
Practice Address - Street 1:705 E 65TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4408
Practice Address - Country:US
Practice Address - Phone:912-234-8935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty