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Organization

FAMILY PRACTICE OF ATLANTA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SONDI SADDIA MOORE-WATERS M.D. (MEDICAL DIRECTOR)
(404) 296-8100
Entity
Organization

Contact information

Practice address
1428 SCOTT BLVD, DECATUR, GA 30030-1424
(404) 296-8100
(404) 294-8467
Mailing address
1428 SCOTT BLVD, DECATUR, GA 30030-1424
(404) 296-8100
(404) 294-8467

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
031294
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
GRP6402
MEDICARE GROUP
GA
Enumeration date
11/16/2007
Last updated
03/04/2010
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