Provider Demographics
NPI:1780836064
Name:FAMILY PRACTICE & SURGERY
Entity type:Organization
Organization Name:FAMILY PRACTICE & SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-444-6521
Mailing Address - Street 1:446 SPRING ST
Mailing Address - Street 2:P.O. BOX 485
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-1983
Mailing Address - Country:US
Mailing Address - Phone:706-444-6521
Mailing Address - Fax:706-444-6839
Practice Address - Street 1:120 SPARTA HWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-8484
Practice Address - Country:US
Practice Address - Phone:706-485-4002
Practice Address - Fax:706-485-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020504208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty