Provider Demographics
NPI:1326935198
Name:FAMILY AND PHYSICAL MEDICINE OF SOUTH ATLANTA
Entity type:Organization
Organization Name:FAMILY AND PHYSICAL MEDICINE OF SOUTH ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-378-4986
Mailing Address - Street 1:696 MOUNT ZION RD STE C4
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1583
Mailing Address - Country:US
Mailing Address - Phone:470-627-3053
Mailing Address - Fax:470-627-3054
Practice Address - Street 1:1635 HIGHWAY 34 E STE D
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2173
Practice Address - Country:US
Practice Address - Phone:470-627-3053
Practice Address - Fax:470-627-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty