Provider Demographics
NPI:1932228160
Name:ATLANTA FAMILY PRACTICE CLINIC ASSOCIATION
Entity Type:Organization
Organization Name:ATLANTA FAMILY PRACTICE CLINIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-796-4133
Mailing Address - Street 1:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-1228
Mailing Address - Country:US
Mailing Address - Phone:903-796-4133
Mailing Address - Fax:903-796-5001
Practice Address - Street 1:506 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-2527
Practice Address - Country:US
Practice Address - Phone:903-796-4133
Practice Address - Fax:903-796-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K54VMedicare ID - Type UnspecifiedGROUP NUMBER