Provider Demographics
NPI:1518924877
Name:CENTER FOR FAMILY MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-657-3360
Mailing Address - Street 1:111 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2503
Mailing Address - Country:US
Mailing Address - Phone:706-657-3360
Mailing Address - Fax:706-657-4400
Practice Address - Street 1:111 N PINE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2503
Practice Address - Country:US
Practice Address - Phone:706-657-3360
Practice Address - Fax:706-657-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002943363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4026Medicare ID - Type UnspecifiedGROUP ID NUMBER
GA97WCGGMMedicare ID - Type Unspecified