Healthcare Provider Details

I. General information

NPI: 1538553094
Provider Name (Legal Business Name): CLEAR CHOICE FAMILY MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 WILLIAMS RD STE D
COLUMBUS GA
31909-5618
US

IV. Provider business mailing address

3151 WILLIAMS RD STE D
COLUMBUS GA
31909-5618
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-7418
  • Fax: 770-822-3032
Mailing address:
  • Phone: 706-507-7418
  • Fax: 770-822-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. PHARONDA LEE
Title or Position: INSURANCE MANAGER
Credential:
Phone: 770-822-3031