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General NPI Number Information
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NPI Number | 1184635039
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Entity Type | Organization
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Legal Business Name | NDC FAMILY CARE, INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-3917
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Country | US
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Telephone | 770-554-8828
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Fax | 770-554-9221
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Provider Business Mailing Address
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Address Line | 3900 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-3917
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Country | US
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Telephone | 770-554-8828
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Fax | 770-554-9221
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Authorized Official
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Title or Position | OWNER/ SOLE PROPRIETOR
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Name | GERMAINE DENISE CUMMINGS
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Credential | M.D.
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Telephone | 770-554-8828
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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 | 052340
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License Number State | GA
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