Provider Demographics
NPI:1184703779
Name:FAMILY MEDICAL CENTER P.C.
Entity type:Organization
Organization Name:FAMILY MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLU
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:JABATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-997-2900
Mailing Address - Street 1:5615 OLD NATIONAL HWY STE D
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3817
Mailing Address - Country:US
Mailing Address - Phone:770-997-2900
Mailing Address - Fax:404-767-7053
Practice Address - Street 1:5615 OLD NATIONAL HWY STE D
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3817
Practice Address - Country:US
Practice Address - Phone:770-997-2900
Practice Address - Fax:404-767-7053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058527207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA058527OtherLICENSE NUMBER