Healthcare Provider Details

I. General information

NPI: 1427251065
Provider Name (Legal Business Name): COLUMBUS AMBULATORY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

PO BOX 1038
COLUMBUS GA
31902-1038
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1823
  • Fax: 706-662-2685
Mailing address:
  • Phone: 706-571-1823
  • Fax: 706-660-2685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LIEN TUCKER-MUSZYNSKI
Title or Position: CREDENTIALING SPECIALIST
Credential: CMA, CPAR
Phone: 706-571-1823