Provider Demographics
NPI:1831119304
Name:GGD, INC.
Entity Type:Organization
Organization Name:GGD, INC.
Other - Org Name:EARLY FAMILY PRACTICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:478-825-3317
Mailing Address - Street 1:PO BOX 5048
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-5048
Mailing Address - Country:US
Mailing Address - Phone:478-825-3317
Mailing Address - Fax:478-825-5499
Practice Address - Street 1:201 AVERA DR
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-5008
Practice Address - Country:US
Practice Address - Phone:478-825-3317
Practice Address - Fax:478-825-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA113961Medicare Oscar/Certification
GAGRP6222Medicare PIN