Healthcare Provider Details

I. General information

NPI: 1225849599
Provider Name (Legal Business Name): THE COLUMBUS ORTHOPAEDIC CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 15TH ST STE 4TH
MERIDIAN MS
39301-4104
US

IV. Provider business mailing address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

V. Phone/Fax

Practice location:
  • Phone: 601-385-9111
  • Fax:
Mailing address:
  • Phone: 662-328-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TAMMY J GAVIN
Title or Position: PRACTICE ADMIN/CREDENTIALING
Credential:
Phone: 662-370-1014