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General NPI Number Information
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NPI Number | 1326935198
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Entity Type | Organization
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Legal Business Name | FAMILY AND PHYSICAL MEDICINE OF SOUTH ATLANTA
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 1635 HIGHWAY 34 E STE D
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City | NEWNAN
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State | GA
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Zip | 30265-2173
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Country | US
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Telephone | 470-627-3053
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Fax | 470-627-3054
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Provider Business Mailing Address
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Address Line | 696 MOUNT ZION RD STE C4
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City | JONESBORO
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State | GA
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Zip | 30236-1583
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Country | US
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Telephone | 470-627-3053
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Fax | 470-627-3054
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Authorized Official
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Title or Position | OWNER
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Name | LEAH HARTPENCE
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Credential | NP
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Telephone | 678-378-4986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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