Healthcare Provider Details

I. General information

NPI: 1407996846
Provider Name (Legal Business Name): FAMILY PRACTICE PARTNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 HWY 20 S.E. SUITE 270
CONYERS GA
30013
US

IV. Provider business mailing address

1910 HWY 20 S.E. SUITE 270
CONYERS GA
30013
US

V. Phone/Fax

Practice location:
  • Phone: 770-761-0501
  • Fax: 770-761-0509
Mailing address:
  • Phone: 770-761-0501
  • Fax: 770-761-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DARYL SHERROD
Title or Position: OFFICE MANAGER
Credential: M.D.
Phone: 770-761-0501