Provider Demographics
NPI:1104640846
Name:FAMILY PRACTICE AND URGENT CARE
Entity type:Organization
Organization Name:FAMILY PRACTICE AND URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:678-625-5431
Mailing Address - Street 1:3812 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4528
Mailing Address - Country:US
Mailing Address - Phone:678-625-5431
Mailing Address - Fax:
Practice Address - Street 1:3812 SALEM RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4528
Practice Address - Country:US
Practice Address - Phone:678-625-5431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty