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General NPI Number Information
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NPI Number | 1609928936
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Entity Type | Organization
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Legal Business Name | COLUMBIA DOCTORS GROUP, SC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1320 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2561
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Country | US
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Telephone | 618-281-4111
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Fax | 618-281-4112
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Provider Business Mailing Address
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Address Line | 1320 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2561
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Country | US
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Telephone | 618-281-4111
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Fax | 618-281-4112
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD GENE WILLIAMS
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Credential | DC
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Telephone | 618-281-4111
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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 |
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License Number State | IL
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