Provider Demographics
NPI:1740440080
Name:FAMILY CARE OF NORTHWEST GEORGIA
Entity type:Organization
Organization Name:FAMILY CARE OF NORTHWEST GEORGIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:706-397-2007
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-0606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2505
Practice Address - Country:US
Practice Address - Phone:706-639-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care