Healthcare Provider Details

I. General information

NPI: 1538122155
Provider Name (Legal Business Name): HIGGSTON FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 US HIGHWAY 280
AILEY GA
30410-3659
US

IV. Provider business mailing address

3101 US HIGHWAY 280
AILEY GA
30410-3659
US

V. Phone/Fax

Practice location:
  • Phone: 912-538-7500
  • Fax:
Mailing address:
  • Phone: 912-538-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: CINDY VANN
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-523-5113