# FAMILY PRACTICE ASSOICATES LLC

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

## Provider details

- **NPI number:** 1972725216
- **Authorized official:** MR. CARL DAVID JOHNSON III MD (PRACTICE OWNER/PHYSICIAN)
- **Authorized official phone:** (229) 391-3300

## Contact information

- **Practice address:** 612 LOVE AVE, TIFTON, GA 31794
- **Practice address phone:** (229) 391-3300
- **Practice address fax:** (229) 388-1948
- **Mailing address:** 612 LOVE AVE, TIFTON, GA 31794
- **Mailing address phone:** (229) 391-3300
- **Mailing address fax:** (229) 388-1948

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 28796 | GA | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 05/08/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 85002772G | — | GA |