MEDICARE: FIRST LOOK PRIMARY CARE, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	050124	GA

General Provider Information

NPI Number	:	1912179649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST LOOK PRIMARY CARE, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 6170
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504
Country	:	US
Telephone Number	:	770-287-8953
Fax Number	:	770-287-8954

Provider Business Practice Location Address
First Line	:	2766 ATLANTA HWY
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-8263
Country	:	US
Telephone Number	:	770-287-8953
Fax Number	:	770-287-8954

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANIS N ANTHONY-WADE
Credential	:	D.O.
Telephone Number	:	770-287-8953

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	11/29/2016

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