Healthcare Provider Details

I. General information

NPI: 1235289448
Provider Name (Legal Business Name): WARNER ROBINS PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CORDER ROAD
WARNER ROBINS GA
31088
US

IV. Provider business mailing address

PO BOX 6908
WARNER ROBINS GA
31095-6908
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-5015
  • Fax: 478-922-5085
Mailing address:
  • Phone: 478-922-5015
  • Fax: 478-922-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number076208
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number076208
License Number StateGA

VIII. Authorized Official

Name: MRS. BRENDA MARIE TRAHAN
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 478-922-5015