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General NPI Number Information
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NPI Number | 1316205073
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Entity Type | Organization
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Legal Business Name | BLAIRSVILLE FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 123 WEAVER RD SUITE B
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3155
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Country | US
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Telephone | 706-745-5556
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Fax | 706-745-1822
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Provider Business Mailing Address
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Address Line | 123 WEAVER ROAD SUITE B
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City | BLAIRSVILLE
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State | GA
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Zip | 30512
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Country | US
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Telephone | 706-745-5556
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Fax | 706-745-1822
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES LANIER HEATON
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Credential | M.D.
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Telephone | 706-745-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 31257
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License Number State | GA
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