1639558539 NPI number — DOUGLAS INTERNAL MEDICINE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639558539 NPI number — DOUGLAS INTERNAL MEDICINE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS INTERNAL MEDICINE P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639558539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 WESTSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLAS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31533-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-383-7826
Provider Business Mailing Address Fax Number:
912-383-7299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 GA HIGHWAY 32 BYP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31510-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-632-7826
Provider Business Practice Location Address Fax Number:
912-383-7299
Provider Enumeration Date:
05/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SINCLAIR
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
STANLEY
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
912-383-7826

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036457 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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