Organization
FAMILY PRACTICE ASSOICATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL DAVID JOHNSON III MD (PRACTICE OWNER/PHYSICIAN)
(229) 391-3300
Entity
Organization
Contact information
Practice address
612 LOVE AVE, TIFTON, GA 31794
(229) 391-3300
(229) 388-1948
Mailing address
612 LOVE AVE, TIFTON, GA 31794
(229) 391-3300
(229) 388-1948
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
28796
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85002772G
—
GA
Enumeration date
05/03/2007
Last updated
05/08/2015
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