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General NPI Number Information
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NPI Number | 1356368088
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Entity Type | Organization
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Legal Business Name | GEORGIA PERSONAL HEALTHCARE
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 4525 HOLLY AVE SUITE B
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City | COLUMBUS
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State | GA
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Zip | 31904-5989
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Country | US
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Telephone | 706-324-6474
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Fax | 706-478-3100
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Provider Business Mailing Address
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Address Line | PO BOX 132
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City | COLUMBUS
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State | GA
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Zip | 31902-0132
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Country | US
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Telephone | 706-324-6474
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MR. NATHAN B HUNTER
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Credential |
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Telephone | 706-324-6474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 050382
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License Number State | GA
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