Healthcare Provider Details

I. General information

NPI: 1861576514
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES OF COLUMBUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 NORTH AVE
COLUMBUS GA
31901-1525
US

IV. Provider business mailing address

1942 NORTH AVE
COLUMBUS GA
31901-1525
US

V. Phone/Fax

Practice location:
  • Phone: 706-596-1245
  • Fax: 706-576-4245
Mailing address:
  • Phone: 706-596-1245
  • Fax: 706-576-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA LYNN SHELLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-596-1245