=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164418703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2005
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 13TH ST
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446-2229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-238-2665
-----------------------------------------------------
Fax | 805-238-7422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 614 13TH ST
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446-2229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-238-2665
-----------------------------------------------------
Fax | 805-238-7422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | DR. OBBIE TED ATKINSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-238-2665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------