Healthcare Provider Details

I. General information

NPI: 1881666725
Provider Name (Legal Business Name): NORTH GEORGIA FAMILY MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 WINDWARD PKWY SUITE 202
ALPHARETTA GA
30004-3850
US

IV. Provider business mailing address

4895 WINDWARD PKWY SUITE 202
ALPHARETTA GA
30004-3850
US

V. Phone/Fax

Practice location:
  • Phone: 678-867-9689
  • Fax:
Mailing address:
  • Phone: 678-867-9689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number49485
License Number StateGA

VIII. Authorized Official

Name: SARA CACERES-CANTU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 678-867-9689