MEDICARE: COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
3	208M00000X	Hospitalist Physician
4	207R00000X	Internal Medicine Physician
5	207X00000X	Orthopaedic Surgery Physician
6	103T00000X	Psychologist
7	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790733244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 117337
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-7337
Country	:	US
Telephone Number	:	770-801-2500
Fax Number	:	470-271-2895

Provider Business Practice Location Address
First Line	:	1800 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3624
Country	:	US
Telephone Number	:	706-571-1120
Fax Number	:	706-660-2685

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MS. TEIRRA WALKER
Credential	:
Telephone Number	:	706-494-4300

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	10/26/2021

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Directions to “COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC. ” Practice Location

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