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General NPI Number Information
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NPI Number | 1811269632
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Entity Type | Organization
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Legal Business Name | SOLAR FAMILY PRACTICE
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 122 SCRANTON CONNECTOR SUITE 112
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City | BRUNSWICK
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State | GA
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Zip | 31525
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Country | US
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Telephone | 912-265-5994
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Fax |
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Provider Business Mailing Address
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Address Line | 122 SCRANTON CONNECTOR SUITE 112
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City | BRUNSWICK
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State | GA
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Zip | 31525
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Country | US
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Telephone | 912-265-5994
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. CHARLES H EVANS
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Credential | NONE
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Telephone | 912-265-5994
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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 | RN120593
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License Number State | GA
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