Healthcare Provider Details

I. General information

NPI: 1598057655
Provider Name (Legal Business Name): ARCHBOLD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MIMOSA DR
THOMASVILLE GA
31792-6676
US

IV. Provider business mailing address

900 CAIRO RD
THOMASVILLE GA
31792-4255
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8881
  • Fax: 229-225-2165
Mailing address:
  • Phone: 229-227-5158
  • Fax: 229-227-5187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES HIGHTOWER
Title or Position: SR. VP/CFO
Credential:
Phone: 229-228-2853