Provider Demographics
NPI:1811124423
Name:PERRY FAMILY PRACTICE
Entity type:Organization
Organization Name:PERRY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:VELIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-988-1515
Mailing Address - Street 1:1025 KEITH DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2948
Mailing Address - Country:US
Mailing Address - Phone:478-988-1515
Mailing Address - Fax:478-988-1550
Practice Address - Street 1:1025 KEITH DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2948
Practice Address - Country:US
Practice Address - Phone:478-988-1515
Practice Address - Fax:478-988-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty