Healthcare Provider Details

I. General information

NPI: 1124051040
Provider Name (Legal Business Name): ARCHBOLD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N JEFFERSON ST
MONTICELLO FL
32344-2060
US

IV. Provider business mailing address

900 CAIRO RD
THOMASVILLE GA
31792
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-2511
  • Fax: 850-997-3022
Mailing address:
  • Phone: 229-227-5104
  • Fax: 229-227-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0085940
License Number StateFL

VIII. Authorized Official

Name: MR. CHARLES D HIGHTOWER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 229-228-2853