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General NPI Number Information
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NPI Number | 1093278186
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Entity Type | Organization
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Legal Business Name | FAMILY CARE DAHLONEGA LLC
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 400 WALMART WAY STE F-B
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City | DAHLONEGA
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State | GA
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Zip | 30533-0829
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Country | US
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Telephone | 706-867-7666
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1357
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City | DAHLONEGA
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State | GA
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Zip | 30533-0023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LINDSAY E FOWLER
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Credential | DO
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Telephone | 706-867-7666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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