NPIMap

Organization Active NPI

Douglas County Family Practice, P.C.

  • Primary Care Clinic/Center
  • Douglasville, GA
National Provider Identifier
1013918671
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
023734 Issued in GA
Legal business name
DOUGLAS COUNTY FAMILY PRACTICE, P.C.
Practice address
3872 Highway 5
Douglasville, GA 30135-3366
Phone
(770) 949-5535
Fax
(770) 949-9022
NPI assigned
Aug 4, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mariam George, M.D.
Title
Family Practice Physician
Phone
(770) 949-5535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 023734 GA Primary

Addresses

Primary practice location

3872 Highway 5
Douglasville, GA 30135-3366

Mailing address

3872 Highway 5
Douglasville, GA 30135-3366
Phone (770) 949-5535

Other identifiers 1

IdentifierTypeStateIssuer
00312826CMedicaidGA

Other names 1

  • Mariam George, M.D. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Douglas County Family Practice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2105 Mack Rd
Douglasville, GA 30135

3872 Highway 5
Douglasville, GA 30135
Phone (770) 949-5534

6025 Professional Pkwy
Ste 300
Douglasville, GA 30134
Phone (770) 489-3969

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1123113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013918671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3872 HIGHWAY 5",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301353366",
            "telephone_number": "770-949-5535",
            "fax_number": "770-949-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3872 HIGHWAY 5",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301353366",
            "telephone_number": "770-949-5535",
            "fax_number": "770-949-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS COUNTY FAMILY PRACTICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_title_or_position": "FAMILY PRACTICE PHYSICIAN",
        "authorized_official_telephone_number": "770-949-5535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "023734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00312826C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mariam George, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.