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General NPI Number Information
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NPI Number | 1922104306
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Entity Type | Organization
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Legal Business Name | PARK CENTRAL FAMILY PRACTICE, INC.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 4367 NEW SNAPFINGER WOODS DR
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City | DECATUR
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State | GA
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Zip | 30035-2920
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Country | US
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Telephone | 770-981-2008
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Fax | 770-981-6302
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Provider Business Mailing Address
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Address Line | 4367 NEW SNAPFINGER WOODS DR
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City | DECATUR
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State | GA
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Zip | 30035-2920
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Country | US
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Telephone | 770-981-2008
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Fax | 770-981-6302
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. TERRIE A ALEXANDER
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Credential |
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Telephone | 770-981-2008
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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 |
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License Number State | GA
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