| Fayetteville Family Practice | |
|
108 N Park Dr Fayetteville GA 30214-1645 | |
| (770) 461-3466 | |
| Not Available |
| Full Name | Fayetteville Family Practice |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 108 N Park Dr, Fayetteville, Georgia |
| Authorized Official Name and Position | John Keller (PRESIDENT) |
| Authorized Official Contact | 7704613466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayetteville Family Practice 108 N Park Dr Fayetteville GA 30214-1645 Ph: (770) 461-3466 | Fayetteville Family Practice 108 N Park Dr Fayetteville GA 30214-1645 Ph: (770) 461-3466 |
| NPI Number | 1407989155 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 04/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407989155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | 020555 (Georgia) | Primary |
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