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General NPI Number Information
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NPI Number | 1952312365
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Entity Type | Organization
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Legal Business Name | PERRY FAMILY MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 938 CARROLL ST
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City | PERRY
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State | GA
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Zip | 31069-3314
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Country | US
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Telephone | 478-987-2212
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Fax | 478-988-1300
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Provider Business Mailing Address
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Address Line | 938 CARROLL ST SUITE 100
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City | PERRY
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State | GA
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Zip | 31069-3314
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Country | US
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Telephone | 478-987-2212
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Fax | 478-988-1300
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY S HAROLD
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Credential | MD
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Telephone | 478-987-2212
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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 | 022774
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License Number State | GA
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