Canton Family Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

015374 Issued in GA

Legal business name

CANTON FAMILY CARE

Practice address

200 Medical LN
Canton, GA 30114-2421

Phone

(770) 479-1494

Fax

(770) 720-3492

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Dorise A House

Title

Insurance Manager

Phone

(770) 479-1494

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Jennifer Field Mark, LPC

  • Professional Counselor
  • Canton, GA
  • NPI 1548336639
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1669526604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MEDICAL LN",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142421",
            "telephone_number": "770-479-1494",
            "fax_number": "770-720-3492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL LN",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301142421",
            "telephone_number": "770-479-1494",
            "fax_number": "770-720-3492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "HOUSE",
        "authorized_official_first_name": "DORISE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "770-479-1494",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "015374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00291189A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Canton Convalescent Center Inc
• Canton Counseling, LLC
• Canton Dental, LLC
• Canton Endodontics,LLC
• Canton Eye Surgery Center
• Canton Institute for Physical Therapy, LLC
• Canton Market Place Medical, LLC
• Canton Marketplace Dentistry LLC
• Canton Northside Pharmacy Inc
• Canton Opco, LLC

• Family Medicine Physician in Canton, GA
• Providers in Canton, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; 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.