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General NPI Number Information
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NPI Number | 1013918671
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Entity Type | Organization
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Legal Business Name | DOUGLAS COUNTY FAMILY PRACTICE, P.C.
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3872 HIGHWAY 5
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3366
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Country | US
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Telephone | 770-949-5535
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Fax | 770-949-9022
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Provider Business Mailing Address
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Address Line | 3872 HIGHWAY 5
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3366
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Country | US
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Telephone | 770-949-5535
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Fax | 770-949-9022
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Authorized Official
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Title or Position | FAMILY PRACTICE PHYSICIAN
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Name | DR. MARIAM GEORGE
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Credential | M.D.
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Telephone | 770-949-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 023734
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License Number State | GA
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