MEDICARE: FAMILY PRIMECARE, 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	022620	GA

General Provider Information

NPI Number	:	1811168883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRIMECARE, LLC

Provider Business Mailing Address
First Line	:	1489 KENNEDY RD
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-4159
Country	:	US
Telephone Number	:	229-391-9931
Fax Number	:	229-391-9961

Provider Business Practice Location Address
First Line	:	1489 KENNEDY RD
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-4159
Country	:	US
Telephone Number	:	229-391-9931
Fax Number	:	229-391-9961

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD PIERZCHAJLO
Credential	:	M.D.
Telephone Number	:	229-391-9931

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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Directions to “FAMILY PRIMECARE, LLC ” Practice Location

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