Healthcare Provider Details

I. General information

NPI: 1013967009
Provider Name (Legal Business Name): MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 10TH AVE
COLUMBUS GA
31901-1529
US

IV. Provider business mailing address

1800 10TH AVE STE H
COLUMBUS GA
31901-1529
US

V. Phone/Fax

Practice location:
  • Phone: 706-321-3777
  • Fax: 706-321-3751
Mailing address:
  • Phone: 706-321-3777
  • Fax: 706-321-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006882
License Number StateGA

VIII. Authorized Official

Name: DEBRA NOWLIN
Title or Position: DIRECTOR OF PHARMACY
Credential: B.S. PHARMACY
Phone: 706-660-2757