Provider Demographics
NPI:1568108850
Name:SOUTHERN FAMILY WALK-IN
Entity Type:Organization
Organization Name:SOUTHERN FAMILY WALK-IN
Other - Org Name:HORMONE AND DIABETIC CENTER OF LAKE OCONEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALFERINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-278-0491
Mailing Address - Street 1:1482 CRAVEN RD
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-1318
Mailing Address - Country:US
Mailing Address - Phone:912-278-0491
Mailing Address - Fax:
Practice Address - Street 1:1129 LAKE OCONEE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9581
Practice Address - Country:US
Practice Address - Phone:912-278-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty