Provider Demographics
NPI:1154582278
Name:MEDICO FAMILIAR INC.
Entity type:Organization
Organization Name:MEDICO FAMILIAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAH
Authorized Official - Middle Name:
Authorized Official - Last Name:INAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-409-7338
Mailing Address - Street 1:5345 JIMMY CARTER BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1524
Mailing Address - Country:US
Mailing Address - Phone:770-409-7338
Mailing Address - Fax:770-409-7339
Practice Address - Street 1:5345 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1524
Practice Address - Country:US
Practice Address - Phone:770-409-7338
Practice Address - Fax:770-409-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047908208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty