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General NPI Number Information
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NPI Number | 1699226001
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Entity Type | Organization
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Legal Business Name | MIDDLE GEORGIA PRIMARY CARE
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 1115 MORNINGSIDE DRIVE
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City | PERRY
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State | GA
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Zip | 31069
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Country | US
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Telephone | 478-988-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 HOUSTON LAKE ROAD APT 1602
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City | KATHLEEN
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State | GA
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Zip | 31047
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Country | US
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Telephone | 478-955-3722
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | APPAVUCHETTY SOUNDAPPAN
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Credential | MD
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Telephone | 478-988-3060
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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 | 215936
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License Number State | GA
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