Healthcare Provider Details

I. General information

NPI: 1528224524
Provider Name (Legal Business Name): COLUMBUS CENTER FOR REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 WHITTLESEY RD
COLUMBUS GA
31909-3011
US

IV. Provider business mailing address

2323 WHITTLESEY RD
COLUMBUS GA
31909-3011
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-6344
  • Fax: 706-653-8933
Mailing address:
  • Phone: 706-653-6344
  • Fax: 706-653-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number047371
License Number StateGA

VIII. Authorized Official

Name: MS. DENICE MACE
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-653-6344