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General NPI Number Information
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NPI Number | 1306140942
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Entity Type | Organization
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Legal Business Name | PANHANDLE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 12/22/2010
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 310 E BYRD AVE SUITE B
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City | BONIFAY
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State | FL
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Zip | 32425-3068
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Country | US
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Telephone | 850-547-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 877 3RD ST SUITE 4
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City | CHIPLEY
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State | FL
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Zip | 32428-1827
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. AYSHIA ELLIS HATCHER
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Credential | MSM
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Telephone | 850-638-4555
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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 | OS8371
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License Number State | FL
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