Provider Demographics
NPI:1366559916
Name:AKRON GENERAL CENTER FOR FAMILY MEDICINE
Entity type:Organization
Organization Name:AKRON GENERAL CENTER FOR FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-344-6047
Mailing Address - Street 1:400 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2433
Mailing Address - Country:US
Mailing Address - Phone:330-344-6047
Mailing Address - Fax:330-344-0002
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6047
Practice Address - Fax:330-344-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKRON GENERAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290886Medicaid
OH3600271Medicare PIN