# NORTH FAYETTE FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053683359
- **Authorized official:** MICHELLE JONES-MARTIN (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (803) 807-9533

## Contact information

- **Practice address:** 101 DEVANT ST, SUITE 902, FAYETTEVILLE, GA 30214-2710
- **Practice address phone:** (770) 716-8228
- **Practice address fax:** (770) 716-6588
- **Mailing address:** 101 DEVANT ST, SUITE 902, FAYETTEVILLE, GA 30214-2710
- **Mailing address phone:** (770) 716-8228
- **Mailing address fax:** (770) 716-6588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 33753 | GA | Yes |

## Other

- **Enumeration date:** 02/01/2012
- **Last updated:** 11/05/2012