Organization
ENTERPRISE FAMILY HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANA M HARRELSON (OFFICE MANAGER)
(478) 745-9559
Entity
Organization
Contact information
Practice address
2192 INGLESIDE AVE, MACON, GA 31204-2030
(478) 745-9880
(478) 745-8611
Mailing address
2192 INGLESIDE AVE, MACON, GA 31204-2030
(478) 745-9880
(478) 745-8611
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
040767
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP4689
MEDICARE GROUP NUMBER
GA
Enumeration date
01/10/2008
Last updated
01/10/2008
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