NPIMap

Organization Active NPI

Heritage Family Practice, LLC

  • Family Medicine Physician
  • McDonough, GA
National Provider Identifier
1912933615
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
055755 Issued in GA
Legal business name
HERITAGE FAMILY PRACTICE, LLC
Practice address
1010 Pennsylvania Ave
McDonough, GA 30253-9101
Phone
(770) 288-3883
Fax
(770) 288-3885
NPI assigned
Jun 24, 2006
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. Mary Teju Guest, M.D.NPI 1740228899
Title
Physician
Phone
(770) 288-3883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 055755 GA Primary

Addresses

Primary practice location

1010 Pennsylvania Ave
McDonough, GA 30253-9101

Mailing address

1010 Pennsylvania Ave
McDonough, GA 30253-9101
Phone (770) 288-3883

National Provider Directory

National Provider Directory

Locations

1010 Pennsylvania Ave
McDonough, GA 30253
Phone (770) 288-3883

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912933615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 PENNSYLVANIA AVE",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302539101",
            "telephone_number": "770-288-3883",
            "fax_number": "770-288-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 PENNSYLVANIA AVE",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302539101",
            "telephone_number": "770-288-3883",
            "fax_number": "770-288-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUEST",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "TEJU",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "770-288-3883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "055755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McDonough, 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.