Healthcare Provider Details

I. General information

NPI: 1356368088
Provider Name (Legal Business Name): GEORGIA PERSONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 HOLLY AVE SUITE B
COLUMBUS GA
31904-5989
US

IV. Provider business mailing address

PO BOX 132
COLUMBUS GA
31902-0132
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-6474
  • Fax: 706-478-3100
Mailing address:
  • Phone: 706-324-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number050382
License Number StateGA

VIII. Authorized Official

Name: MR. NATHAN B HUNTER
Title or Position: ADMINSTRATOR
Credential:
Phone: 706-324-6474