MEDICARE: FAMILY FIRST HEALTHCARE P.C.

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	040613	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	:	1730315870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST HEALTHCARE P.C.

Provider Business Mailing Address
First Line	:	939 THORNTON RD
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2634
Country	:	US
Telephone Number	:	770-739-1233
Fax Number	:	770-948-4930

Provider Business Practice Location Address
First Line	:	939 THORNTON RD
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2634
Country	:	US
Telephone Number	:	770-739-1233
Fax Number	:	770-948-4930

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRYAN D BLAKE
Credential	:	M.D.
Telephone Number	:	770-739-1233

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	02/03/2012

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Practice Location Address:

939 THORNTON RD
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1306860044 — MR. MILLARD JAMES COLLIER M.D.
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1306905765 — PHYSIOTHERAPY ASSOCIATES
Practice Location Address:

939 THORNTON RD
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Practice Fax: 770-739-3881

1306906532 — ONDRELL MOORE
Practice Location Address:

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30122-2634

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1437362225 — WEST ATLANTA PEDIATRICS, P.C.
Practice Location Address:

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1437386315 — LINDSEY MANGHAM RANSOM M.D.
Practice Location Address:

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Practice Fax:

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