Provider Demographics
NPI:1508950569
Name:LANIER FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LANIER FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-205-5581
Mailing Address - Street 1:PO BOX 1852
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-1852
Mailing Address - Country:US
Mailing Address - Phone:770-205-5518
Mailing Address - Fax:770-205-5519
Practice Address - Street 1:5830 BOND STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-205-5518
Practice Address - Fax:770-205-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37636207P00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE67825Medicare UPIN
GA08BBSFBMedicare ID - Type Unspecified