Provider Demographics
NPI:1881786630
Name:FAMILY PRACTICE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:FAMILY PRACTICE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-679-0899
Mailing Address - Street 1:280 VIRGINIA AVE NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1538
Mailing Address - Country:US
Mailing Address - Phone:276-679-0899
Mailing Address - Fax:276-679-0803
Practice Address - Street 1:280 VIRGINIA AVE NE
Practice Address - Street 2:SUITE 106
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1538
Practice Address - Country:US
Practice Address - Phone:276-679-0899
Practice Address - Fax:276-679-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABO9755Medicare UPIN