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General NPI Number Information
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NPI Number | 1821268467
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Entity Type | Organization
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Legal Business Name | COLUMBUS PULMONARY CLINIC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 255 BAPTIST BLVD STE 302
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City | COLUMBUS
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State | MS
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Zip | 39705-2011
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Country | US
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Telephone | 662-327-3195
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Fax | 662-243-1070
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Provider Business Mailing Address
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Address Line | PO BOX 8401
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City | COLUMBUS
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State | MS
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Zip | 39705-0010
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Country | US
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Telephone | 662-327-3195
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Fax | 662-243-1070
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KELLI AVERY
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Credential |
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Telephone | 662-327-3195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 13124
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License Number State | MS
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