Provider Demographics
NPI:1669683546
Name:NDC FAMILY CARE INC
Entity Type:Organization
Organization Name:NDC FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:770-554-8828
Mailing Address - Street 1:3900 HWY 81 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3917
Mailing Address - Country:US
Mailing Address - Phone:770-554-8828
Mailing Address - Fax:770-554-9221
Practice Address - Street 1:3900 HWY 81 SOUTH
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3917
Practice Address - Country:US
Practice Address - Phone:770-554-8828
Practice Address - Fax:770-554-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052340302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1871544775OtherINDIVIDUAL NPI#1871544775
GA052340OtherLICENSE# 052340
GAH89202Medicare UPIN
GA08CBBSCMedicare ID - Type UnspecifiedPROVIDER 08CBBSC