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General NPI Number Information
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NPI Number | 1730418021
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Entity Type | Organization
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Legal Business Name | SOUTHWEST GEORGIA CENTER OF MEDICINE, LLC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 915 ELMO ST
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City | AMERICUS
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State | GA
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Zip | 31709-3710
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Country | US
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Telephone | 229-389-2038
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Fax | 229-924-9899
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Provider Business Mailing Address
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Address Line | 915 ELMO ST
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City | AMERICUS
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State | GA
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Zip | 31709-3710
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Country | US
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Telephone | 229-389-2038
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Fax | 229-924-9899
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC N CODNER
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Credential | DC
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Telephone | 229-389-2038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029865
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License Number State | GA
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