Healthcare Provider Details

I. General information

NPI: 1609655646
Provider Name (Legal Business Name): ST. FRANCIS PHYSICIAN PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MANCHESTER EXPY
COLUMBUS GA
31904-6802
US

IV. Provider business mailing address

2300 MANCHESTER EXPY
COLUMBUS GA
31904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-2766
  • Fax: 706-320-2768
Mailing address:
  • Phone: 706-320-2766
  • Fax: 706-320-2768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHNETTA M TRAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 502-596-6063