Healthcare Provider Details

I. General information

NPI: 1124800545
Provider Name (Legal Business Name): MERCYMED OF COLUMBUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 21ST ST APT 3101
COLUMBUS GA
31901-1057
US

IV. Provider business mailing address

3702 2ND AVE
COLUMBUS GA
31904-7408
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-9209
  • Fax: 706-507-9249
Mailing address:
  • Phone: 706-507-9209
  • Fax: 706-507-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY NGUYEN
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 706-507-9209