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General NPI Number Information
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NPI Number | 1932454790
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Entity Type | Organization
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Legal Business Name | TATE MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 88 CLINIC RD.
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City | TATE
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State | GA
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Zip | 30177
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Country | US
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Telephone | 404-310-1383
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 680
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City | TATE
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State | GA
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Zip | 30177-0680
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | NANCY Q. LEFEVER
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Credential | M.D.
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Telephone | 404-310-1383
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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 | 050205
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License Number State | GA
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