Healthcare Provider Details

I. General information

NPI: 1114884863
Provider Name (Legal Business Name): ARCHBOLD MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 E JACKSON ST
THOMASVILLE GA
31792-4789
US

IV. Provider business mailing address

1019 E JACKSON ST
THOMASVILLE GA
31792-4789
US

V. Phone/Fax

Practice location:
  • Phone: 229-236-6742
  • Fax: 229-236-6746
Mailing address:
  • Phone: 229-236-6742
  • Fax: 229-236-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LOREN RIALS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 229-228-2853