| Dallas Family Practice Center Pa | |
|
318 Main St Ste B Dallas GA 30132-4266 | |
| (770) 445-1095 | |
| (770) 445-5361 |
| Full Name | Dallas Family Practice Center Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 318 Main St, Dallas, Georgia |
| Authorized Official Name and Position | John G Sparti (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 7704451095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dallas Family Practice Center Pa Po Box 89 Dallas GA 30132-0002 Ph: (770) 445-1095 | Dallas Family Practice Center Pa 318 Main St Ste B Dallas GA 30132-4266 Ph: (770) 445-1095 |
| NPI Number | 1568466035 |
|---|---|
| Provider Enumeration Date | 06/12/2005 |
| Last Update Date | 12/08/2010 |
| Medicare PECOS PAC ID | 2567452758 |
|---|---|
| Medicare Enrollment ID | O20040518000857 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568466035 | NPI | - | NPPES |
| 00063764A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 16148 (Georgia) | Primary |
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