Healthcare Provider Details

I. General information

NPI: 1659592137
Provider Name (Legal Business Name): SOUTH COLUMBUS FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SAINT MARYS RD
COLUMBUS GA
31907-7626
US

IV. Provider business mailing address

4000 SAINT MARYS RD
COLUMBUS GA
31907-7626
US

V. Phone/Fax

Practice location:
  • Phone: 706-685-2770
  • Fax: 706-685-3299
Mailing address:
  • Phone: 706-685-2770
  • Fax: 706-685-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number036581
License Number StateGA

VIII. Authorized Official

Name: SHABBIR MOTIWALA
Title or Position: MD
Credential:
Phone: 706-685-2770