Healthcare Provider Details

I. General information

NPI: 1144245812
Provider Name (Legal Business Name): HOWARD GEORGE VIGRASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 10TH AVE
COLUMBUS GA
31901-1513
US

IV. Provider business mailing address

PO BOX 1038
COLUMBUS GA
31902-1038
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1120
  • Fax:
Mailing address:
  • Phone: 706-571-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number017566
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: