Provider Demographics
NPI:1841579067
Name:ABERCORN FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:ABERCORN FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLINGFORD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-656-9938
Mailing Address - Street 1:PO BOX 60967
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31420-0967
Mailing Address - Country:US
Mailing Address - Phone:912-201-3144
Mailing Address - Fax:
Practice Address - Street 1:8880 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4508
Practice Address - Country:US
Practice Address - Phone:912-201-3144
Practice Address - Fax:912-349-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty