MEDICARE: GRANT PARK FAMILY HEALTH CENTER, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1871669358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANT PARK FAMILY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	1340 BOULEVARD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-3016
Country	:	US
Telephone Number	:	404-627-4259
Fax Number	:	404-624-5795

Provider Business Practice Location Address
First Line	:	1340 BOULEVARD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-3016
Country	:	US
Telephone Number	:	404-627-4259
Fax Number	:	404-624-5795

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. TERRY W. WOOD
Credential	:	M.D.
Telephone Number	:	404-627-4259

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/22/2020

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