Healthcare Provider Details

I. General information

NPI: 1396582136
Provider Name (Legal Business Name): THE FAMILY HEALTH CENTERS OF GEORGIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 MERCHANTS WAY
MORROW GA
30260-2342
US

IV. Provider business mailing address

868 YORK AVE SW
ATLANTA GA
30310-2750
US

V. Phone/Fax

Practice location:
  • Phone: 770-961-2508
  • Fax:
Mailing address:
  • Phone: 404-752-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL W BROOKS
Title or Position: CEO
Credential: MD
Phone: 404-752-1400