MEDICARE: GREATER ATLANTA FAMILY HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	046281	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	046281	OTHER	GA	STATE OF GA

General Provider Information

NPI Number	:	1215932751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER ATLANTA FAMILY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3700 MARKET ST
Second Line	:	STE C
City	:	CLARKSTON
State	:	GA
Zip	:	30021-2652
Country	:	US
Telephone Number	:	404-298-9333
Fax Number	:	404-298-9931

Provider Business Practice Location Address
First Line	:	3700 MARKET ST
Second Line	:	STE C
City	:	CLARKSTON
State	:	GA
Zip	:	30021-2652
Country	:	US
Telephone Number	:	404-298-9333
Fax Number	:	404-298-9931

Authorized Official
Title or Position	:	DOCTOR
Name	:	DOROTHY A.O. WHITE-WILLIAMS
Credential	:	MD
Telephone Number	:	404-298-9333

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/22/2020

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