Family Practice & Urgent Care

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

056841 Issued in GA

Legal business name

FAMILY PRACTICE & URGENT CARE

Practice address

3812 Salem Rd
Covington, GA 30016-4528

Phone

(678) 625-5431

Fax

(678) 625-5455

NPI assigned

Jul 9, 2008

Last updated

Jul 9, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Eastlyn Eloise Harding-Marin, M.DNPI 1912944083

Title

Medical Director

Phone

(678) 625-5431

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eastlyn E Harding-Marin, M.D.

  • Family Medicine Physician
  • Ellenwood, GA
  • NPI 1912944083
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1568625457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 SALEM RD",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164528",
            "telephone_number": "678-625-5431",
            "fax_number": "678-625-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3812 SALEM RD",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164528",
            "telephone_number": "678-625-5431",
            "fax_number": "678-625-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PRACTICE & URGENT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "HARDING-MARIN",
        "authorized_official_first_name": "EASTLYN",
        "authorized_official_middle_name": "ELOISE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-625-5431",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "GA",
            "license": "056841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Practice and Urgent Care
• Family Practice Immediate Care Associate Limited Liability Company
• Valerie Elaine Fanning, DNP
• Sofia Osman Farah
• Kourosh Farahvashi, OD

• Health Service Clinic/Center in Covington, GA
• Providers in Covington, GA by specialty
• Health Service Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.