Provider Demographics
NPI:1154360626
Name:PRESTON FAMILY CLINIC
Entity type:Organization
Organization Name:PRESTON FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-887-3366
Mailing Address - Street 1:533 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:GA
Mailing Address - Zip Code:31824-3817
Mailing Address - Country:US
Mailing Address - Phone:229-887-3366
Mailing Address - Fax:
Practice Address - Street 1:300 ALSTON ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:GA
Practice Address - Zip Code:31825-1406
Practice Address - Country:US
Practice Address - Phone:229-887-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility