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General NPI Number Information
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NPI Number | 1568466035
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Entity Type | Organization
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Legal Business Name | DALLAS FAMILY PRACTICE CENTER PA
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Dates
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Enumeration Date | 06/12/2005
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 318 MAIN ST STE B
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City | DALLAS
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State | GA
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Zip | 30132-4266
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Country | US
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Telephone | 770-445-1095
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Fax | 770-445-5361
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Provider Business Mailing Address
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Address Line | PO BOX 89
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City | DALLAS
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State | GA
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Zip | 30132-0002
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Country | US
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Telephone | 770-445-1095
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Fax | 770-445-5361
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | JOHN G SPARTI
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Credential | D.O.
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Telephone | 770-445-1095
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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 | 16148
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License Number State | GA
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