Provider Demographics
NPI:1922019850
Name:WALNUT CREEK FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:WALNUT CREEK FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLAVICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-898-7840
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-0688
Mailing Address - Country:US
Mailing Address - Phone:770-898-7840
Mailing Address - Fax:770-898-7960
Practice Address - Street 1:4303 JODECO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8297
Practice Address - Country:US
Practice Address - Phone:770-898-7840
Practice Address - Fax:770-898-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty