Provider Demographics
NPI:1700526142
Name:J & G FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:J & G FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NGUM
Authorized Official - Middle Name:
Authorized Official - Last Name:AVWONTOM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:301-404-1989
Mailing Address - Street 1:6614 WINDSOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5381
Mailing Address - Country:US
Mailing Address - Phone:301-404-1989
Mailing Address - Fax:
Practice Address - Street 1:6614 WINDSOR MILL RD
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5381
Practice Address - Country:US
Practice Address - Phone:301-404-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty