Provider Demographics
NPI:1831321280
Name:FIRSTMED OF FORSYTH
Entity type:Organization
Organization Name:FIRSTMED OF FORSYTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDGINS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:770-889-0006
Mailing Address - Street 1:907 BUFORD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-2710
Mailing Address - Country:US
Mailing Address - Phone:770-889-0006
Mailing Address - Fax:770-889-2749
Practice Address - Street 1:907 BUFORD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2710
Practice Address - Country:US
Practice Address - Phone:770-889-0006
Practice Address - Fax:770-889-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023840261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45830Medicare UPIN