Provider Demographics
NPI:1760632780
Name:MEMORIAL HEALTH PARTNERS FOUNDATION INC
Entity Type:Organization
Organization Name:MEMORIAL HEALTH PARTNERS FOUNDATION INC
Other - Org Name:CHI MEMORIAL FAMILY PRACTICE ASSOCIATES - LAFAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAELOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-495-8659
Mailing Address - Street 1:PO BOX 749748
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9748
Mailing Address - Country:US
Mailing Address - Phone:423-495-8659
Mailing Address - Fax:423-495-4970
Practice Address - Street 1:615 E VILLANOW ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2618
Practice Address - Country:US
Practice Address - Phone:706-638-1606
Practice Address - Fax:706-638-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4692210004Medicare NSC