OrganizationHeritage Family Practice, LlcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1010 Pennsylvania Ave, Mcdonough, GA 30253-9101(770) 288-3883PECOS EnrollmentBased on the most recent information from CMS, provider Heritage Family Practice, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1912933615Provider TypeOrganizationFull NameHeritage Family Practice, LlcSubpartNoEnumeration Date6/24/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address1010 Pennsylvania Ave, Mcdonough, GA 30253-9101Phone(770) 288-3883Fax(770) 288-3885Mailing LocationMailing Address1010 Pennsylvania Ave, Mcdonough, GA 30253-9101Phone(770) 288-3883Fax(770) 288-3885Authorized OfficialNameGuest, Mary Teju (Physician)Phone(770) 288-3883Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense055755Georgia