Basic Information
| Provider Information | |||||||||
| NPI: | 1922258946 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEMORIAL HEALTH PARTNERS FOUNDATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TCFPA FAMILY MEDICAL CENTERS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 116638 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303686638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954912 | ||||||||
| FaxNumber: | 4234954970 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 BATTLEFIELD PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307365166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068614990 | ||||||||
| FaxNumber: | 7068619405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2008 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | REGISTER | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4234956870 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.