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General NPI Number Information
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NPI Number | 1407973936
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Entity Type | Organization
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Legal Business Name | GENESYS FAMILY PRACTICE, INC.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 120 HANDLEY RD SUITE 410
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City | TYRONE
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State | GA
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Zip | 30290
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Country | US
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Telephone | 770-964-5810
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Fax | 678-364-1216
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Provider Business Mailing Address
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Address Line | 120 HANDLEY RD SUITE 410
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City | TYRONE
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State | GA
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Zip | 30290
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Country | US
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Telephone | 770-964-5810
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Fax | 678-364-1216
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Authorized Official
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Title or Position | OWNER
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Name | IVY YVONNE SMITH
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Credential | MD
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Telephone | 770-964-5810
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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 | 053075
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License Number State | GA
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