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General NPI Number Information
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NPI Number | 1689796435
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 8662 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-1328
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Country | US
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Telephone | 937-890-8580
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Fax | 937-890-9652
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Provider Business Mailing Address
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Address Line | 8662 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-1328
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Country | US
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Telephone | 937-890-8580
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Fax | 937-890-9652
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL ANNE GILL
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Credential | D.O.
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Telephone | 937-890-8580
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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 | 34-006157
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License Number State | OH
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