Provider Demographics
NPI:1053584722
Name:SNAPFINGER WOODS FAMILY PRACTICE GROUP
Entity type:Organization
Organization Name:SNAPFINGER WOODS FAMILY PRACTICE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LATANYA
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-981-0600
Mailing Address - Street 1:5071 SNAPFINGER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4019
Mailing Address - Country:US
Mailing Address - Phone:770-981-0600
Mailing Address - Fax:770-981-0677
Practice Address - Street 1:5071 SNAPFINGER WOODS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4019
Practice Address - Country:US
Practice Address - Phone:770-981-0600
Practice Address - Fax:770-981-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB30002Medicare UPIN
GA01BDDWHMedicare PIN