Fairmount Family Medicine Pc | |
2712 Highway 411 Se Fairmount GA 30139-3219 | |
(706) 337-1930 | |
(706) 337-1910 |
Full Name | Fairmount Family Medicine Pc |
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Speciality | Nurse Practitioner - Family |
Location | 2712 Highway 411 Se, Fairmount, Georgia |
Authorized Official Name and Position | Tony Lewis Sparks (PRESIDENT) |
Authorized Official Contact | 7063371930 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Fairmount Family Medicine Pc Po Box 703 Fairmount GA 30139-0703 Ph: (706) 337-1930 | Fairmount Family Medicine Pc 2712 Highway 411 Se Fairmount GA 30139-3219 Ph: (706) 337-1930 |
NPI Number | 1548559339 |
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Provider Enumeration Date | 04/01/2011 |
Last Update Date | 04/01/2011 |
Identifier | Type | State | Issuer |
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1548559339 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 32319 (Georgia) | Secondary |
363LF0000X | Nurse Practitioner - Family | RN107315 (Georgia) | Primary |