=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275772477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY FAMILY MEDICINE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2009
-----------------------------------------------------
Last Update Date | 05/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2864 E CHEROKEE DR STE G
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-704-2763
-----------------------------------------------------
Fax | 770-704-2765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2864 E CHEROKEE DR STE G
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30115-8693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-704-2763
-----------------------------------------------------
Fax | 770-704-2765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. KATHRYN P. NEELY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 770-704-2763
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 046189
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------