Provider Demographics
NPI:1942352778
Name:COVINGTON FAMILY CARE AND SPECIALTY GROUP
Entity Type:Organization
Organization Name:COVINGTON FAMILY CARE AND SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-284-7744
Mailing Address - Street 1:3546 COVINGTON HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1823
Mailing Address - Country:US
Mailing Address - Phone:404-284-7744
Mailing Address - Fax:404-284-8006
Practice Address - Street 1:3546 COVINGTON HWY
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1823
Practice Address - Country:US
Practice Address - Phone:404-284-7744
Practice Address - Fax:404-284-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044791261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA610247700OtherOWCP-DCMWC
GA000778016CMedicaid
GA000778016CMedicaid
GAGRP6492Medicare PIN
GA610247700OtherOWCP-DCMWC
GAP00231885Medicare ID - Type UnspecifiedRAILROAD MEDICARE