Healthcare Provider Details

I. General information

NPI: 1841202876
Provider Name (Legal Business Name): JEFFREY RYMUZA, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 WATSON BLVD
WARNER ROBINS GA
31093-3432
US

IV. Provider business mailing address

PO BOX 7617
WARNER ROBINS GA
31095-7617
US

V. Phone/Fax

Practice location:
  • Phone: 478-923-5786
  • Fax: 478-329-8820
Mailing address:
  • Phone: 478-923-5786
  • Fax: 478-329-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number031112
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number031112
License Number StateGA

VIII. Authorized Official

Name: JEFFREY Z RYMUZA
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 478-923-5786