Provider Demographics
NPI:1194914135
Name:ATLANTA FAMILY PHYSICIANS PC
Entity type:Organization
Organization Name:ATLANTA FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:JINGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-968-8269
Mailing Address - Street 1:3424 FLAT SHOALS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6525
Mailing Address - Country:US
Mailing Address - Phone:404-968-8269
Mailing Address - Fax:404-968-8274
Practice Address - Street 1:3424 FLAT SHOALS RD
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6525
Practice Address - Country:US
Practice Address - Phone:404-968-8269
Practice Address - Fax:404-968-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045842261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110229622OtherMEDICARE R/R
GAGRP3465OtherMEDICARE GROUP NO.
GA11BDQPMOtherMEDICARE
GA00804339DMedicaid