Organization
CHATTAHOOCHEE VALLEY FAMILY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY A DILLARD MD (SENIOR PARTNER)
(334) 291-8322
Entity
Organization
Contact information
Practice address
1810 STADIUM DRIVE STE 240, PHENIX CITY, AL 36867
(334) 291-8303
(334) 291-8325
Mailing address
1810 STADIUM DRIVE STE 240, PHENIX CITY, AL 36867
(334) 291-8303
(334) 291-8325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009907905
—
AL
05
—
009907915
—
AL
01
—
51512167
BCBS AL
AL
01
—
51512168
BCBS AL
AL
01
—
52051956-003
BCBS GA
GA
01
—
52669717-001
BCBS GA
GA
Enumeration date
08/22/2006
Last updated
07/02/2010
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