Organization
FAMILY MEDICINE AT NORTHSIDE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PICKETT (VP)
(678) 762-5037
Entity
Organization
Contact information
Practice address
420 CHARTER BLVD, SUITE 3003, MACON, GA 31210-4854
(478) 475-4886
(478) 475-4896
Mailing address
420 CHARTER BLVD, SUITE 3003, MACON, GA 31210-4854
(478) 475-4886
(478) 475-4896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/06/2006
Last updated
04/20/2008
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