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General NPI Number Information
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NPI Number | 1417120809
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Entity Type | Organization
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Legal Business Name | G. JERYL EVERIDGE, M.D.,P.C.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 2022 10TH AVE SUITE A
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City | COLUMBUS
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State | GA
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Zip | 31901-3724
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Country | US
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Telephone | 706-324-0081
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Fax | 706-324-1965
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Provider Business Mailing Address
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Address Line | 2022 10TH AVE SUITE A
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City | COLUMBUS
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State | GA
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Zip | 31901-3724
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Country | US
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Telephone | 706-324-0081
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Fax | 706-324-1965
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GEORGE JERYL EVERIDGE
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Credential | M.D.
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Telephone | 706-324-0081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14906
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License Number State | GA
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