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General NPI Number Information
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NPI Number | 1558354787
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Entity Type | Organization
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Legal Business Name | MUNSAYAC MEDICAL CLINIC
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 308 MAIN ST
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City | LUMBER CITY
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State | GA
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Zip | 31549-9752
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Country | US
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Telephone | 912-363-4389
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Fax | 912-363-1377
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Provider Business Mailing Address
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Address Line | PO BOX 519
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City | LUMBER CITY
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State | GA
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Zip | 31549-0519
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Country | US
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Telephone | 912-363-4389
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Fax | 912-363-1377
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUMAWIG Y MUNSAYAC
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Credential | M.D.
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Telephone | 912-363-4389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 015028
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License Number State | GA
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