Provider Demographics
NPI:1952312365
Name:PERRY FAMILY MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:PERRY FAMILY MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAROLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-987-2212
Mailing Address - Street 1:938 CARROLL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3314
Mailing Address - Country:US
Mailing Address - Phone:478-987-2212
Mailing Address - Fax:478-988-1300
Practice Address - Street 1:938 CARROLL ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3314
Practice Address - Country:US
Practice Address - Phone:478-987-2212
Practice Address - Fax:478-988-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4809OtherMEDICARE GROUP #
GADA4451OtherMEDICARE RAILROAD GROUP #