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General NPI Number Information
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NPI Number | 1194870998
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Entity Type | Organization
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Legal Business Name | FISCHBACH FAMILY MEDICINE & OPTHAMOLOGY
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 721 RICHLAND AVE W SUITE 200
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City | AIKEN
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State | SC
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Zip | 29801-3831
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Country | US
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Telephone | 803-643-3400
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Fax | 803-643-3440
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Provider Business Mailing Address
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Address Line | 3772 IVEY LANE
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City | LILBURN
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State | GA
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Zip | 30047-2156
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Country | US
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Telephone | 803-643-3400
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Fax | 803-643-3440
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Authorized Official
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Title or Position | OWNER
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Name | GARY T FISCHBACH
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Credential | M.D.
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Telephone | 803-643-3400
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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 | 0502521
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License Number State | SC
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