Healthcare Provider Details

I. General information

NPI: 1992238935
Provider Name (Legal Business Name): HOUSTON PHYSICIAN SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N HOUSTON RD STE 101
WARNER ROBINS GA
31093-3074
US

IV. Provider business mailing address

233 N HOUSTON RD STE. 101
WARNER ROBINS GA
31093-3074
US

V. Phone/Fax

Practice location:
  • Phone: 478-352-7010
  • Fax: 478-352-7019
Mailing address:
  • Phone: 478-352-7010
  • Fax: 478-352-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN WHILDEN
Title or Position: CFO
Credential:
Phone: 478-542-7959