1962948414 NPI number — THE MEDICAL CENTER INC. JBACC LOCATION

Table of content: (NPI 1962948414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962948414 NPI number — THE MEDICAL CENTER INC. JBACC LOCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEDICAL CENTER INC. JBACC LOCATION
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:
PIEDMONT COLUMBUS REGIONAL MIDTOWN - JOHN B AMOS CANCER CENTER
Provider Other Organization Name Type Code:
3
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:
1962948414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1831 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904-8915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-321-6600
Provider Business Mailing Address Fax Number:
706-321-6695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1831 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904-8915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-321-6600
Provider Business Practice Location Address Fax Number:
706-321-6695
Provider Enumeration Date:
01/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NOWLIN
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
706-660-2757

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHH007938 , 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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