Healthcare Provider Details

I. General information

NPI: 1740440080
Provider Name (Legal Business Name): FAMILY CARE OF NORTHWEST GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 N DUKE ST
LA FAYETTE GA
30728-2505
US

IV. Provider business mailing address

PO BOX 606
LA FAYETTE GA
30728-0606
US

V. Phone/Fax

Practice location:
  • Phone: 706-639-9055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH EDWARD BOWERS II
Title or Position: PRESIDENT
Credential: M.D.
Phone: 706-397-2007