Healthcare Provider Details

I. General information

NPI: 1821047721
Provider Name (Legal Business Name): INTERNAL MEDICINE EDUCATION & RESEARCH FOUNDATION OF COLUMBUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

PO BOX 311
COLUMBUS GA
31902-0311
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1527
  • Fax: 706-660-2750
Mailing address:
  • Phone: 706-571-1527
  • Fax: 706-660-2750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. JUDITH G. ANDERSON
Title or Position: SECRETARY
Credential:
Phone: 706-571-1454