Family Medical Clinic of Snellville

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

023958 Issued in GA

Legal business name

FAMILY MEDICAL CLINIC OF SNELLVILLE

Practice address

3891 Stone Mountain Hwy
Snellville, GA 30039-3932

Phone

(770) 972-4764

Fax

(770) 972-4164

NPI assigned

Jul 29, 2008

Organization subpart

No

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

Authorized official

Name

Gordon Glenn Freeman, M.D.

Title

President

Phone

(770) 972-4764

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1568628618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3891 STONE MOUNTAIN HWY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300393932",
            "telephone_number": "770-972-4764",
            "fax_number": "770-972-4164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3891 STONE MOUNTAIN HWY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300393932",
            "telephone_number": "770-972-4764",
            "fax_number": "770-972-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CLINIC OF SNELLVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-29",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-972-4764",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "023958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC PROVIDER ID",
            "identifier": "52260821001",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND. NPI",
            "identifier": "1083652267",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "4073314",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Extended Grace Counseling, LLC
• Extraordinary Family Healthcare
• Kaitlyn Eyer
• James Fabricant, RBT
• Sabrina O. Falkner, M.D.
• Family Medicine of Gwinnett, LLC
• Family Nutrition Solutions, LLC
• Babatunde A Famuyiwa, AA
• Idil Farah
• Patricia Farley, PH.D.

• Primary Care Clinic/Center in Snellville, GA
• Providers in Snellville, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; 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.