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General NPI Number Information
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NPI Number | 1720300387
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST HEALTHCARE OF NORTHEAST GEORGIA
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 11973 AUGUSTA RD
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City | LAVONIA
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State | GA
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Zip | 30553-1283
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Country | US
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Telephone | 706-356-8181
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Fax | 706-356-8081
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Provider Business Mailing Address
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Address Line | 11973 AUGUSTA RD
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City | LAVONIA
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State | GA
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Zip | 30553-1283
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Country | US
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Telephone | 706-356-8181
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Fax | 706-356-8081
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NICOLE FORD
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Credential | NP
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Telephone | 706-356-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN144697NP
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | RN144697NP
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN144697NP
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN144697NP
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License Number State | GA
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