Provider Demographics
NPI:1811269632
Name:SOLAR FAMILY PRACTICE
Entity type:Organization
Organization Name:SOLAR FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:912-265-5994
Mailing Address - Street 1:122 SCRANTON CONNECTOR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525
Mailing Address - Country:US
Mailing Address - Phone:912-265-5994
Mailing Address - Fax:
Practice Address - Street 1:122 SCRANTON CONNECTOR
Practice Address - Street 2:SUITE 112
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525
Practice Address - Country:US
Practice Address - Phone:912-265-5994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN120593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty