Healthcare Provider Details

I. General information

NPI: 1205967312
Provider Name (Legal Business Name): OCCUPATIONAL MEDICINE OF COLUMBUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N LAKE DR
COLUMBUS GA
31909-2788
US

IV. Provider business mailing address

7301 N LAKE DR
COLUMBUS GA
31909-2788
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-1600
  • Fax: 706-221-1605
Mailing address:
  • Phone: 706-221-1600
  • Fax: 706-221-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number028079
License Number StateGA

VIII. Authorized Official

Name: CHARLENE THOMAS
Title or Position: ASSISTANT OFFICE MANAGER
Credential:
Phone: 706-221-1600