Provider Demographics
NPI:1912093584
Name:GEORGIA FAMILY CARE, LLC
Entity Type:Organization
Organization Name:GEORGIA FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DHARMESHKUMAR
Authorized Official - Middle Name:CHHAGANLAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-205-4999
Mailing Address - Street 1:5900 HILLANDALE DRIVE
Mailing Address - Street 2:ANNEX B
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3802
Mailing Address - Country:US
Mailing Address - Phone:678-205-4999
Mailing Address - Fax:678-205-4969
Practice Address - Street 1:5900 HILLANDALE DRIVE
Practice Address - Street 2:ANNEX B
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3802
Practice Address - Country:US
Practice Address - Phone:678-205-4999
Practice Address - Fax:678-205-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA959033244AMedicaid
GA08BBSDMMedicare ID - Type UnspecifiedPROVIDER ID
GA959033244AMedicaid