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General NPI Number Information
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NPI Number | 1811168883
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Entity Type | Organization
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Legal Business Name | FAMILY PRIMECARE, LLC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 1489 KENNEDY RD
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City | TIFTON
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State | GA
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Zip | 31794-4159
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Country | US
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Telephone | 229-391-9931
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Fax | 229-391-9961
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Provider Business Mailing Address
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Address Line | 1489 KENNEDY RD
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City | TIFTON
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State | GA
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Zip | 31794-4159
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Country | US
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Telephone | 229-391-9931
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Fax | 229-391-9961
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD PIERZCHAJLO
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Credential | M.D.
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Telephone | 229-391-9931
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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 | 022620
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License Number State | GA
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