Healthcare Provider Details

I. General information

NPI: 1477521813
Provider Name (Legal Business Name): OWASA FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 HOSPITAL DR
CALHOUN GA
30701-2067
US

IV. Provider business mailing address

109 HOSPITAL DR
CALHOUN GA
30701-2067
US

V. Phone/Fax

Practice location:
  • Phone: 706-625-0333
  • Fax: 706-625-1269
Mailing address:
  • Phone: 706-625-0333
  • Fax: 706-625-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06968
License Number StateGA

VIII. Authorized Official

Name: DENNY BIDDINGER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 706-625-0333