Organization
FAMILYCARE MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTORIA H. THEDFORD M.D. (OWNER)
(770) 968-1997
Entity
Organization
Contact information
Practice address
6685 MERCHANTS WAY, SUITE B, MORROW, GA 30260-2342
(770) 968-1997
(770) 968-1918
Mailing address
PO BOX 783, REX, GA 30273-0783
(770) 968-1997
(770) 968-1918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
054039
GA
207R00000X
Internal Medicine Physician
054039
GA
208000000X
Pediatrics Physician
054039
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187347049E
—
GA
Enumeration date
04/30/2009
Last updated
04/30/2009
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