Provider Demographics
NPI:1598560443
Name:FAMILY PRACTICE IMMEDIATE CARE ASSOCIATE LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:FAMILY PRACTICE IMMEDIATE CARE ASSOCIATE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:678-558-2638
Mailing Address - Street 1:3812 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4528
Mailing Address - Country:US
Mailing Address - Phone:678-625-5431
Mailing Address - Fax:678-625-5455
Practice Address - Street 1:3812 SALEM RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4528
Practice Address - Country:US
Practice Address - Phone:678-625-5431
Practice Address - Fax:678-625-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty