Healthcare Provider Details

I. General information

NPI: 1417120809
Provider Name (Legal Business Name): G. JERYL EVERIDGE, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 10TH AVE SUITE A
COLUMBUS GA
31901-3724
US

IV. Provider business mailing address

2022 10TH AVE SUITE A
COLUMBUS GA
31901-3724
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-0081
  • Fax: 706-324-1965
Mailing address:
  • Phone: 706-324-0081
  • Fax: 706-324-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14906
License Number StateGA

VIII. Authorized Official

Name: GEORGE JERYL EVERIDGE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 706-324-0081