Healthcare Provider Details

I. General information

NPI: 1629062336
Provider Name (Legal Business Name): RIVER CITY ORTHOPAEDICS AND SPINE MEDICINE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 10TH AVE STE 320
COLUMBUS GA
31901-3600
US

IV. Provider business mailing address

1900 10TH AVE STE 320
COLUMBUS GA
31901-3600
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-6635
  • Fax: 706-653-8543
Mailing address:
  • Phone: 706-653-6635
  • Fax: 706-653-8543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number39717
License Number StateGA

VIII. Authorized Official

Name: EMORY JEVODE ALEXANDER
Title or Position: OWNER FOUNDER CEO MD
Credential: MD
Phone: 706-653-6635