Provider Demographics
NPI:1558502781
Name:FAMILY PRACTICE & SURGERY LLC
Entity type:Organization
Organization Name:FAMILY PRACTICE & SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-444-6521
Mailing Address - Street 1:446 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-1983
Mailing Address - Country:US
Mailing Address - Phone:706-444-6521
Mailing Address - Fax:706-444-6839
Practice Address - Street 1:446 SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1983
Practice Address - Country:US
Practice Address - Phone:706-444-6521
Practice Address - Fax:706-444-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty