Healthcare Provider Details

I. General information

NPI: 1831446905
Provider Name (Legal Business Name): COLUMBUS CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 17TH ST
COLUMBUS GA
31901-3500
US

IV. Provider business mailing address

PO BOX 84052
COLUMBUS GA
31908-4052
US

V. Phone/Fax

Practice location:
  • Phone: 706-243-4404
  • Fax:
Mailing address:
  • Phone: 706-243-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000814
License Number StateGA

VIII. Authorized Official

Name: MR. JAMES ZACHARIAS
Title or Position: CEO
Credential:
Phone: 706-243-4404