Healthcare Provider Details

I. General information

NPI: 1447279740
Provider Name (Legal Business Name): BYRON A LITTLEFIELD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COMMERCE PKWY
ADAIRSVILLE GA
30103-2009
US

IV. Provider business mailing address

PO BOX 12938 C/O CLINIC MANAGEMENT
CALHOUN GA
30703-7013
US

V. Phone/Fax

Practice location:
  • Phone: 770-773-9201
  • Fax: 770-773-9219
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number028810
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: