Healthcare Provider Details

I. General information

NPI: 1841110707
Provider Name (Legal Business Name): JOSHUA INGRAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 12TH ST
COLUMBUS GA
31901-2523
US

IV. Provider business mailing address

421 12TH ST
COLUMBUS GA
31901-2523
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-7796
  • Fax:
Mailing address:
  • Phone: 706-604-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: