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General NPI Number Information
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NPI Number | 1598560443
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE IMMEDIATE CARE ASSOCIATE LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 3812 SALEM RD
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City | COVINGTON
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State | GA
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Zip | 30016-4528
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Country | US
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Telephone | 678-625-5431
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Fax | 678-625-5455
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Provider Business Mailing Address
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Address Line | 3812 SALEM RD
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City | COVINGTON
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State | GA
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Zip | 30016-4528
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Country | US
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Telephone | 678-625-5431
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Fax | 678-625-5455
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Authorized Official
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Title or Position | OWNER
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Name | MARGARET BLANCHE LYONS
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Credential | FNP
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Telephone | 678-558-2638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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