Provider Demographics
NPI:1568861326
Name:GOOD SHEPHERD CLINIC
Entity Type:Organization
Organization Name:GOOD SHEPHERD CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-960-5701
Mailing Address - Street 1:6392 MURPHY DR
Mailing Address - Street 2:PO BOX 6
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1714
Mailing Address - Country:US
Mailing Address - Phone:770-960-5701
Mailing Address - Fax:770-968-2701
Practice Address - Street 1:6392 MURPHY DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1714
Practice Address - Country:US
Practice Address - Phone:770-960-5701
Practice Address - Fax:770-968-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health