Organization
BASDEN FAMILY PRACTICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYL BASDEN D.O. (OWNER)
(404) 362-0282
Entity
Organization
Contact information
Practice address
4940 GOVERNORS DR, SUITE 203, FOREST PARK, GA 30297-2186
(404) 362-0282
(404) 362-0285
Mailing address
4940 GOVERNORS DR, SUITE 203, FOREST PARK, GA 30297-2186
(404) 362-0282
(404) 362-0285
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
030951
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP6406
MEDICARE ID
GA
Enumeration date
05/23/2008
Last updated
05/23/2008
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