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General NPI Number Information
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NPI Number | 1053867929
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Entity Type | Organization
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Legal Business Name | EMPOWER FAMILY MEDICINE
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 209 SWANTON WAY STE A SUITE 101
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City | DECATUR
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State | GA
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Zip | 30030-3274
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Country | US
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Telephone | 404-981-6278
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Fax |
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Provider Business Mailing Address
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Address Line | 115 ANSLEY ST
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City | DECATUR
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State | GA
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Zip | 30030-5211
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Country | US
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Telephone | 404-981-6278
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. MELISSA BLACK
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Credential | MD
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Telephone | 404-981-6278
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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 | 056266
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License Number State | GA
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