Provider Demographics
NPI:1861915647
Name:316 FAMILY MEDICINE
Entity type:Organization
Organization Name:316 FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-634-8905
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-0728
Mailing Address - Country:US
Mailing Address - Phone:770-537-1234
Mailing Address - Fax:770-537-1235
Practice Address - Street 1:222 GORDON ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-1519
Practice Address - Country:US
Practice Address - Phone:770-537-1234
Practice Address - Fax:770-537-1237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:316 HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-24
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003540147OtherNPI
1457021628OtherNPI
1821630971OtherNPI
1841754611OtherNPI
1952951535OtherNPI
1154862910OtherNPI
1265208318OtherNPI
1295123792OtherNPI
1407005085OtherNPI
1598047730OtherNPI
1669710786OtherNPI
1871781476OtherNPI
GA059986OtherSTATE LICENSE NUMBER
1265154884OtherNPI
1669982088OtherNPI
1184171886OtherNPI
1932556453OtherNPI
1932730306OtherNPI
1407443252OtherNPI
1811282346OtherNPI
1952854572OtherNPI
1023769965OtherNPI
1225441967OtherNPI
1407291925OtherNPI
1962851352OtherNPI