Provider Demographics
NPI:1902088164
Name:UNITED FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:UNITED FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERUWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-632-6093
Mailing Address - Street 1:7794 ELLA LN STE G
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5512
Mailing Address - Country:US
Mailing Address - Phone:770-632-6093
Mailing Address - Fax:770-632-6095
Practice Address - Street 1:7794 ELLA LN STE G
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5512
Practice Address - Country:US
Practice Address - Phone:770-632-6093
Practice Address - Fax:770-632-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH33782Medicare UPIN