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General NPI Number Information
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NPI Number | 1104025717
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER FAMILY PRACTICE
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 45 MEDICAL CENTER CT
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City | COMMERCE
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State | GA
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Zip | 30529-1085
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Country | US
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Telephone | 706-335-5155
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Fax | 706-335-5256
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Provider Business Mailing Address
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Address Line | 45 MEDICAL CENTER CT
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City | COMMERCE
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State | GA
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Zip | 30529-1085
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Country | US
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Telephone | 706-335-5155
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Fax | 706-335-5256
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT MARSHBURN
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Credential | MD
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Telephone | 706-335-5155
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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 | 030139
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License Number State | GA
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