Healthcare Provider Details

I. General information

NPI: 1922346162
Provider Name (Legal Business Name): COLUMBUS PHYSICAL MEDICINE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 ENTERPRISE CT SUITE B
COLUMBUS GA
31904-9229
US

IV. Provider business mailing address

118 ENTERPRISE CT SUITE B
COLUMBUS GA
31904-9229
US

V. Phone/Fax

Practice location:
  • Phone: 706-225-7008
  • Fax:
Mailing address:
  • Phone: 706-225-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number029865
License Number StateGA

VIII. Authorized Official

Name: ERIC N CODNER
Title or Position: OWNER/PARTNER
Credential:
Phone: 706-330-1389