Organization
FAIRMOUNT FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY LEWIS SPARKS FNP (PRESIDENT)
(706) 337-1930
Entity
Organization
Contact information
Practice address
2712 HIGHWAY 411 SE, FAIRMOUNT, GA 30139-3219
(706) 337-1930
(706) 337-1910
Mailing address
PO BOX 703, FAIRMOUNT, GA 30139-0703
(706) 337-1930
(706) 337-1910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
32319
GA
363LF0000X
Family Nurse Practitioner
Primary
RN107315
GA
Other
Enumeration date
04/01/2011
Last updated
04/01/2011
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