Healthcare Provider Details

I. General information

NPI: 1124386479
Provider Name (Legal Business Name): UNITED MEDICAL SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 TOMMY STALNAKER DR
WARNER ROBINS GA
31088-8960
US

IV. Provider business mailing address

203 TOMMY STALNAKER DR
WARNER ROBINS GA
31088-8960
US

V. Phone/Fax

Practice location:
  • Phone: 478-225-2949
  • Fax: 478-293-1958
Mailing address:
  • Phone: 478-225-2949
  • Fax: 478-293-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAYTH A SAYMEH
Title or Position: OWNER
Credential: MD
Phone: 478-225-2949