=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245325448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBUS MEDICAL ONCOLOGY ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 11/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 WARM SPRINGS RD STE A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-7953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-653-2525
-----------------------------------------------------
Fax | 706-653-2527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 WARM SPRINGS RD STE A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-7953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-653-2525
-----------------------------------------------------
Fax | 706-653-2527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | SAJID AHMED
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 706-653-2525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 048202
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------