Provider Demographics
NPI:1396996955
Name:CHATTAHOOCHEE VALLEY FAMILY MEDICINE INC
Entity type:Organization
Organization Name:CHATTAHOOCHEE VALLEY FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-570-5337
Mailing Address - Street 1:7413 WHITESVILLE RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3227
Mailing Address - Country:US
Mailing Address - Phone:706-570-5337
Mailing Address - Fax:
Practice Address - Street 1:7413 WHITESVILLE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3227
Practice Address - Country:US
Practice Address - Phone:706-570-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053465261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care