Basic Information
| Provider Information | |||||||||
| NPI: | 1881899821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY HEALTHCARE OF SMYRNA, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 VILLAGE GREEN CIRCLE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703840284 | ||||||||
| FaxNumber: | 4044461957 | ||||||||
| Practice Location | |||||||||
| Address1: | 3969 S COBB DR SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300806358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704382942 | ||||||||
| FaxNumber: | 7704386560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 11/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | VISHWANATH | ||||||||
| AuthorizedOfficialFirstName: | MADHU | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7704382942 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 056499 | GA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 056499 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.