Provider Demographics
NPI:1679962716
Name:FAMILY CENTERED MIDWIFERY CARE, LLC
Entity Type:Organization
Organization Name:FAMILY CENTERED MIDWIFERY CARE, LLC
Other - Org Name:OB/GYN & MIDWIFE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:404-349-2112
Mailing Address - Street 1:2719 FELTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3603
Mailing Address - Country:US
Mailing Address - Phone:404-349-2112
Mailing Address - Fax:404-767-6553
Practice Address - Street 1:2719 FELTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3603
Practice Address - Country:US
Practice Address - Phone:404-349-2112
Practice Address - Fax:404-767-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN066207176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000596296GMedicaid