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General NPI Number Information
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NPI Number | 1861915647
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Entity Type | Organization
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Legal Business Name | 316 FAMILY MEDICINE
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 222 GORDON ST
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City | BREMEN
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State | GA
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Zip | 30110-1519
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Country | US
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Telephone | 770-537-1234
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Fax | 770-537-1237
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Provider Business Mailing Address
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Address Line | PO BOX 728
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City | BREMEN
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State | GA
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Zip | 30110-0728
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Country | US
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Telephone | 770-537-1234
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Fax | 770-537-1235
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | NOELLE SMITH
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Credential |
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Telephone | 770-634-8905
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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 | 059986
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License Number State | GA
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