Provider Demographics
NPI:1023281011
Name:PHYSICIANS FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:PHYSICIANS FAMILY MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-456-0911
Mailing Address - Street 1:209 COOLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180
Mailing Address - Country:US
Mailing Address - Phone:770-456-0911
Mailing Address - Fax:678-827-0622
Practice Address - Street 1:209 COOLEY DRIVE
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180
Practice Address - Country:US
Practice Address - Phone:770-456-0911
Practice Address - Fax:678-827-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care