Provider Demographics
NPI:1598172769
Name:A & A FAMILY MEDICAL
Entity Type:Organization
Organization Name:A & A FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES-PRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-296-9193
Mailing Address - Street 1:47 WHITEGRASS CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4180
Mailing Address - Country:US
Mailing Address - Phone:770-296-9193
Mailing Address - Fax:
Practice Address - Street 1:47 WHITEGRASS CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4180
Practice Address - Country:US
Practice Address - Phone:770-296-9193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058155261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA220156218Medicaid
GA220156218Medicaid
GA08CBBWMMedicare PIN