| Elite Family Medicine | |
|
1000 Brookstone Centre Pkwy Columbus GA 31904-4675 | |
| (762) 261-3334 | |
| (762) 261-3335 |
| Full Name | Elite Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 Brookstone Centre Pkwy, Columbus, Georgia |
| Authorized Official Name and Position | Susan White (CEO) |
| Authorized Official Contact | 7064574781 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Family Medicine 850 Brookstone Centre Pkwy Ste 200 Columbus GA 31904-9245 Ph: (706) 507-4242 | Elite Family Medicine 1000 Brookstone Centre Pkwy Columbus GA 31904-4675 Ph: (762) 261-3334 |
| NPI Number | 1679089296 |
|---|---|
| Provider Enumeration Date | 12/19/2017 |
| Last Update Date | 01/25/2024 |
| Medicare PECOS PAC ID | 2264787761 |
|---|---|
| Medicare Enrollment ID | O20180625003504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679089296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Daniel E Kosobucki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881775518 PECOS PAC ID: 6507856085 Enrollment ID: I20040517000271 |
| Provider Name | Marseea L Howard |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1710084181 PECOS PAC ID: 1254302813 Enrollment ID: I20040805000692 |
| Provider Name | Linda Jill Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134116106 PECOS PAC ID: 6103885009 Enrollment ID: I20050419000816 |
| Provider Name | Richard Stephens |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1003858861 PECOS PAC ID: 3072525880 Enrollment ID: I20060619000066 |
| Provider Name | Ronald M Hudson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548257611 PECOS PAC ID: 3779668132 Enrollment ID: I20080904000405 |
| Provider Name | Eunice A Ampiaw |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962499137 PECOS PAC ID: 1052496411 Enrollment ID: I20080905000483 |
| Provider Name | William A Whitten |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548261480 PECOS PAC ID: 5395811400 Enrollment ID: I20080912000555 |
| Provider Name | John M Jenkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700896503 PECOS PAC ID: 7517003783 Enrollment ID: I20091002000013 |
| Provider Name | Maria Elena Bendana |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881859825 PECOS PAC ID: 2365615358 Enrollment ID: I20111108000639 |
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