| Southern Crescent Family Practice, Llc | |
|
525 Forest Pkwy Suite 100 Forest Park GA 30297-2149 | |
| (678) 705-0100 | |
| (678) 235-1800 |
| Full Name | Southern Crescent Family Practice, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 525 Forest Pkwy, Forest Park, Georgia |
| Authorized Official Name and Position | Faith A Andrews (OWNER) |
| Authorized Official Contact | 6787050100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Crescent Family Practice, Llc 525 Forest Pkwy Suite 100 Forest Park GA 30297-2149 Ph: (678) 705-0100 | Southern Crescent Family Practice, Llc 525 Forest Pkwy Suite 100 Forest Park GA 30297-2149 Ph: (678) 705-0100 |
| NPI Number | 1396923538 |
|---|---|
| Provider Enumeration Date | 02/08/2008 |
| Last Update Date | 05/15/2008 |
| Medicare PECOS PAC ID | 9032015367 |
|---|---|
| Medicare Enrollment ID | O20031209000282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396923538 | NPI | - | NPPES |
| 555253916A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 044158 (Georgia) | Primary |
| Provider Name | Faith A Andrews |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558430280 PECOS PAC ID: 5193621423 Enrollment ID: I20031210000015 |
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