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General NPI Number Information
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NPI Number | 1245406438
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Entity Type | Organization
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Legal Business Name | FAMILY CARE CLINIC P.C.
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 3985 STEVE REYNOLDS BLVD BUILDING I
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City | NORCROSS
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State | GA
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Zip | 30093
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Country | US
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Telephone | 770-622-3948
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Fax | 770-622-4879
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Provider Business Mailing Address
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Address Line | 3985 STEVE REYNOLDS BLVD BUILDING I
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City | NORCROSS
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State | GA
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Zip | 30093
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Country | US
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Telephone | 770-622-3948
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MR. NINO RENZO FORNASINI
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Credential | M.D.
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Telephone | 770-622-3948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 048628
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License Number State | GA
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