MEDICARE: FAMILY HEALTH GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208D00000X	General Practice Physician
3	363A00000X	Physician Assistant
4	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336199041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	854 W JAMES CAMPBELL BLVD
Second Line	:	SUITE 303
City	:	COLUMBIA
State	:	TN
Zip	:	38401-4659
Country	:	US
Telephone Number	:	931-540-4255
Fax Number	:	931-490-4654

Provider Business Practice Location Address
First Line	:	107 J V MANGUAT DR
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-2440
Country	:	US
Telephone Number	:	931-722-2800
Fax Number	:	931-722-9627

Authorized Official
Title or Position	:	CEO
Name	:	MR. HAROLD E PRESTON
Credential	:
Telephone Number	:	931-540-4255

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	06/10/2009

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Directions to “FAMILY HEALTH GROUP INC ” Practice Location

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