Bremen Family Medicine – General Practice Physician

Key facts

NPI: 1003023987
Entity type: Organization (NPI type 2)
Primary specialty: General Practice Physician 208D00000X
License: 034852 (GA)
Legal business name: BREMEN FAMILY MEDICINE
Practice address: 308 Carrollton St
Bremen, GA 30110-2015
Phone: (770) 537-1960
Fax: (770) 537-1901
NPI assigned: May 17, 2007
Organization subpart: No

Authorized official

Name: Regina L Holloway, MD
Title: Owner
Phone: (770) 537-1960

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Regina Lorren Holloway, MD Family Medicine Physician · Bremen, GA · NPI 1063584324

Medicare reassignment NPD GA

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
11D1067856	Bremen Family Medicine 308 Carrollton Street, Bremen, GA 30110	Certificate of waiver	Apr 26, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20050310000684	GA	Part B Supplier - Clinic/Group Practice	8921052044	Receives reassigned benefits from 1 practitioner Practice locations: Bremen, GA

National Provider Directory

Locations

308 Carrollton St
Bremen, GA 30110
Phone (770) 537-1960

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Physician Group: 193400000X SINGLE SPECIALTY GROUP	208D00000X	034852	GA	Yes

Addresses

Primary practice location

308 Carrollton St
Bremen, GA 30110-2015

Mailing address

327 Old Bushmill Rd
Bremen, GA 30110-3835
Phone (770) 537-1960

Other identifiers

Identifier	Type	State	Issuer
00478552H	Medicaid	GA

Other providers in Bremen, GA

All providers in Bremen, GA · General Practice Physician in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.