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General NPI Number Information
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NPI Number | 1174898878
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Entity Type | Organization
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Legal Business Name | FAMILY CARE GROUP OF THOMSON, INC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 123 N WASHINGTON ST
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City | LINCOLNTON
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State | GA
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Zip | 30817
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Country | US
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Telephone | 706-359-6070
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Fax | 706-359-7370
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Provider Business Mailing Address
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Address Line | PO BOX 780
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City | THOMSON
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State | GA
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Zip | 30824-0780
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Country | US
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Telephone | 706-595-1090
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Fax | 706-595-6010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARYL C WILEY
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Credential | MD
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Telephone | 706-595-1090
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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 | GA032327
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License Number State | GA
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