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Organization

GENESYS FAMILY PRACTICE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
IVY YVONNE SMITH MD (OWNER)
(770) 964-5810
Entity
Organization

Contact information

Practice address
120 HANDLEY RD, SUITE 410, TYRONE, GA 30290
(770) 964-5810
(678) 364-1216
Mailing address
120 HANDLEY RD, SUITE 410, TYRONE, GA 30290
(770) 964-5810
(678) 364-1216

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
053075
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
088BRJB
MEDICARE ID
GA
05
407530212B
GA
Enumeration date
03/22/2007
Last updated
08/12/2008
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