Healthcare Provider Details

I. General information

NPI: 1255794541
Provider Name (Legal Business Name): PHOEBE PHYSICIAN GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 3RD AVE STE 700
ALBANY GA
31701-1969
US

IV. Provider business mailing address

500 W 3RD AVE STE 101
ALBANY GA
31701-1985
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-7790
  • Fax: 229-312-7795
Mailing address:
  • Phone: 229-312-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number059422
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number059422
License Number StateGA

VIII. Authorized Official

Name: JEFF HEAD
Title or Position: CFO
Credential:
Phone: 229-312-6721