MEDICARE: DALLAS FAMILY PRACTICE CENTER PA

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	16148	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

General Provider Information

NPI Number	:	1568466035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS FAMILY PRACTICE CENTER PA

Provider Business Mailing Address
First Line	:	PO BOX 89
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-0002
Country	:	US
Telephone Number	:	770-445-1095
Fax Number	:	770-445-5361

Provider Business Practice Location Address
First Line	:	318 MAIN ST
Second Line	:	STE B
City	:	DALLAS
State	:	GA
Zip	:	30132-4266
Country	:	US
Telephone Number	:	770-445-1095
Fax Number	:	770-445-5361

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	JOHN G SPARTI
Credential	:	D.O.
Telephone Number	:	770-445-1095

Provider Enumeration Date	:	06/12/2005
Last Update Date	:	12/08/2010

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Directions to “DALLAS FAMILY PRACTICE CENTER PA ” Practice Location

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