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General NPI Number Information
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NPI Number | 1669325643
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Entity Type | Organization
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Legal Business Name | MIDDLE GA FAMILY PRACTICE
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 1085 PLAZA AVE STE A
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City | EASTMAN
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State | GA
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Zip | 31023-9102
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Country | US
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Telephone | 478-220-5444
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Fax | 478-559-1073
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Provider Business Mailing Address
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Address Line | 1085 PLAZA AVE STE A
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City | EASTMAN
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State | GA
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Zip | 31023-9102
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Country | US
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Telephone | 478-220-5444
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Fax | 478-559-1073
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Authorized Official
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Title or Position | CLAIMS SPECIALIST
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Name | JINA J FORDHAM
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Credential |
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Telephone | 478-220-5444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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