Provider Demographics
NPI:1184635039
Name:NDC FAMILY CARE, INC
Entity type:Organization
Organization Name:NDC FAMILY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-554-8828
Mailing Address - Street 1:3900 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3917
Mailing Address - Country:US
Mailing Address - Phone:770-554-8828
Mailing Address - Fax:770-554-9221
Practice Address - Street 1:3900 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3917
Practice Address - Country:US
Practice Address - Phone:770-554-8828
Practice Address - Fax:770-554-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH89202Medicare UPIN