1366687592 NPI number — COLUMBUS MEDICAL SERVICES

Table of content: (NPI 1366687592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366687592 NPI number — COLUMBUS MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS MEDICAL SERVICES
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:
1366687592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 CORPORATE PLAZA PKWY SE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080-2969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-916-1091
Provider Business Mailing Address Fax Number:
770-916-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 CANAL ST
Provider Second Line Business Practice Location Address:
UNTI 507
Provider Business Practice Location Address City Name:
POOLER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31322-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-748-0580
Provider Business Practice Location Address Fax Number:
912-748-1333
Provider Enumeration Date:
12/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
770-916-1091

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000979052J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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