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General NPI Number Information
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NPI Number | 1285099739
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Entity Type | Organization
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Legal Business Name | COLUMBUS PEDIATRIC ASSOCIATES, PC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 1800 10TH AVE SUITE 100-F
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City | COLUMBUS
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State | GA
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Zip | 31901-1513
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Country | US
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Telephone | 706-221-4602
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Fax | 706-221-4620
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Provider Business Mailing Address
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Address Line | 1800 10TH AVE SUITE 100-F
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City | COLUMBUS
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State | GA
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Zip | 31901-1513
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Country | US
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Telephone | 706-221-4602
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Fax | 706-221-4620
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Authorized Official
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Title or Position | OWNER
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Name | DONNA J YEISER
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Credential | MD
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Telephone | 706-221-4602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 042981
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License Number State | GA
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