Provider Demographics
NPI:1588818389
Name:EVERGREEN FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:EVERGREEN FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:CHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-545-8380
Mailing Address - Street 1:3635 PEACHTREE INDUSTRIAL BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2806
Mailing Address - Country:US
Mailing Address - Phone:770-545-8380
Mailing Address - Fax:770-545-8383
Practice Address - Street 1:3635 PEACHTREE INDUSTRIAL BLVD STE 550
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2806
Practice Address - Country:US
Practice Address - Phone:770-545-8380
Practice Address - Fax:770-545-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty