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General NPI Number Information
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NPI Number | 1871669358
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Entity Type | Organization
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Legal Business Name | GRANT PARK FAMILY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1340 BOULEVARD SE
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City | ATLANTA
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State | GA
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Zip | 30315-3016
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Country | US
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Telephone | 404-627-4259
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Fax | 404-624-5795
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Provider Business Mailing Address
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Address Line | 1340 BOULEVARD SE
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City | ATLANTA
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State | GA
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Zip | 30315-3016
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Country | US
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Telephone | 404-627-4259
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Fax | 404-624-5795
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. TERRY W. WOOD
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Credential | M.D.
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Telephone | 404-627-4259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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