| Columbus Memory Center, Pc | |
|
7196 N Lake Dr Columbus GA 31909-1693 | |
| (706) 327-4000 | |
| (706) 324-2557 |
| Full Name | Columbus Memory Center, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7196 N Lake Dr, Columbus, Georgia |
| Authorized Official Name and Position | Jonathan Leonard Liss (PRESIDENT) |
| Authorized Official Contact | 7063274000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbus Memory Center, Pc 7196 N Lake Dr Columbus GA 31909-1693 Ph: (706) 327-4000 | Columbus Memory Center, Pc 7196 N Lake Dr Columbus GA 31909-1693 Ph: (706) 327-4000 |
| NPI Number | 1083171607 |
|---|---|
| Provider Enumeration Date | 03/01/2019 |
| Last Update Date | 07/16/2024 |
| Certification Date | 07/16/2024 |
| Medicare PECOS PAC ID | 7214364819 |
|---|---|
| Medicare Enrollment ID | O20200220001083 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083171607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 261QR0208X | Clinic/center - Radiology, Mobile | (* (Not Available)) | Secondary |
| Provider Name | Jonathan L Liss |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1386613743 PECOS PAC ID: 8325933856 Enrollment ID: I20040219000269 |
| Provider Name | Jose Alfonso Canedo |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306979828 PECOS PAC ID: 4284805862 Enrollment ID: I20110913000362 |
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