Fayette Care Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAYETTE CARE CLINIC

Practice address

1260 Highway 54 W Ste 101
Fayetteville, GA 30214-4525

Phone

(770) 719-4620

Fax

(770) 719-4622

NPI assigned

May 10, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Williams

Title

Practice Coordinator

Phone

(770) 719-4620

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1003552282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 HIGHWAY 54 W STE 101",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144525",
            "telephone_number": "770-719-4620",
            "fax_number": "770-719-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 HIGHWAY 54 W STE 101",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144525",
            "telephone_number": "770-719-4620",
            "fax_number": "770-719-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PRACTICE COORDINATOR",
        "authorized_official_telephone_number": "770-719-4620"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Medicine Specialist, PC
• Lindsey Bryant Fannin
• Mattie Mae Farmer Clark, CST/CSFA
• Shamarra Jackson Farmer, RN
• Toniya Marie Farmer, DPT
• Fayette Community Hospital, Inc.
• Fayette County Board of Health
• Fayette Dental Group PC
• Fayette Emergency Group LLC
• Fayette Eye Center PC

• All providers in Fayetteville, GA
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.