Provider Demographics
NPI:1649819343
Name:FAITH FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:FAITH FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-490-7777
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0741
Mailing Address - Country:US
Mailing Address - Phone:912-490-7777
Mailing Address - Fax:912-490-7778
Practice Address - Street 1:2100 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-7020
Practice Address - Country:US
Practice Address - Phone:912-490-7777
Practice Address - Fax:912-490-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty