Healthcare Provider Details

I. General information

NPI: 1285099739
Provider Name (Legal Business Name): COLUMBUS PEDIATRIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 10TH AVE SUITE 100-F
COLUMBUS GA
31901-1513
US

IV. Provider business mailing address

1800 10TH AVE SUITE 100-F
COLUMBUS GA
31901-1513
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-4602
  • Fax: 706-221-4620
Mailing address:
  • Phone: 706-221-4602
  • Fax: 706-221-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number042981
License Number StateGA

VIII. Authorized Official

Name: DONNA J YEISER
Title or Position: OWNER
Credential: MD
Phone: 706-221-4602