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General NPI Number Information
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NPI Number | 1699717199
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Entity Type | Organization
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Legal Business Name | GERIATRICS & FAMILY MEDICINE CENTER OF COLUMBUS, P. C.
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 7196 N LAKE DR SUITE B
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City | COLUMBUS
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State | GA
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Zip | 31909-1693
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Country | US
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Telephone | 706-256-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 7196 N LAKE DR SUITE B
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City | COLUMBUS
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State | GA
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Zip | 31909-1693
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Country | US
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Telephone | 706-256-3500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | DR. JIBIKE JOY ADEGBILE
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Credential | M.D.
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Telephone | 706-256-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 048967
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License Number State | GA
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