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500 18th St Suite B-30 Columbus GA 31901-1536 | |
| (706) 321-3765 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 500 18th St, Columbus, Georgia |
| Authorized Official Name and Position | Roland Thacker (SR. VICE PRESIDENT/CFO) |
| Authorized Official Contact | 7065711200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 18th St Suite B-30 Columbus GA 31901-1536 Ph: (706) 321-3765 | 500 18th St Suite B-30 Columbus GA 31901-1536 Ph: (706) 321-3765 |
| NPI Number | 1104130749 |
|---|---|
| Provider Enumeration Date | 08/05/2010 |
| Last Update Date | 08/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104130749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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