MCDONOUGH PRIMARY CARE INC NPI 1710058953

NPI Information

  • NPI: 1710058953
  • Provider Name: MCDONOUGH PRIMARY CARE INC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Other Name: KEYS FERRY MEDICAL CENTER
  • CLIA Number: 11D2261126
  • Address: 68 HAMPTON ST
    MCDONOUGH, GA
    ZIP 30253
  • Phone: (770) 914-0342

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NPI Details

MCDONOUGH PRIMARY CARE INC is a family medicine in Mcdonough, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MCDONOUGH PRIMARY CARE INC NPI is 1710058953. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Keys Ferry Medical Center.

The provider's business location address is:

68 HAMPTON ST
MCDONOUGH, GA
ZIP 30253-150
Phone: (770) 914-0342
Fax: (770) 914-0493

The provider's authorized official is William Harrell Van Laar .
The authorized official title is Owner and has the following contact phone number (770) 914-0342.

The CLIA number assigned to this NPI record is 11D2261126 - other - fire dept with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/10/2006 and was last updated on 11/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1O1BDFLNMEDICARE ID-TYPE UNSPECIFIEDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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