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General NPI Number Information
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NPI Number | 1437346509
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE CLINIC PC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 696 GRAYSON HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-6372
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Country | US
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Telephone | 770-963-0927
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Fax | 770-963-9772
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Provider Business Mailing Address
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Address Line | 696 GRAYSON HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-6372
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Country | US
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Telephone | 770-963-0927
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Fax | 770-963-9772
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHEILA JEANNE SMITH
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Credential | DO
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Telephone | 770-963-0927
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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 | 20001
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License Number State | GA
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