MEDICARE: THE FAMILY HEALTH CENTERS OF GEORGIA, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1720692783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY HEALTH CENTERS OF GEORGIA, INC

Provider Business Mailing Address
First Line	:	868 YORK AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-2750
Country	:	US
Telephone Number	:	404-752-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 PROFESSIONAL PKWY STE 200
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5610
Country	:	US
Telephone Number	:	404-752-1400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL WAYNE BROOKS
Credential	:	MD
Telephone Number	:	404-756-8738

Provider Enumeration Date	:	09/06/2020
Last Update Date	:	09/06/2020

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