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NPI Code Detail

MEDICARE: EDWIN L PAGE M.D.

MEDICARE: EDWIN L PAGE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician041635GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
204BDBPVOTHERGAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598730285
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWIN L PAGE M.D.
Provider Business Mailing Address
First Line : PO BOX 370
Second Line :
City : FORTSON
State : GA
Zip : 31808-0370
Country : US
Telephone Number : 706-494-3071
Fax Number : 706-494-3008
Provider Business Practice Location Address
First Line : 1900 10TH AVE STE 211
Second Line :
City : COLUMBUS
State : GA
Zip : 31901-3604
Country : US
Telephone Number : 706-324-6661
Fax Number : 706-494-3008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 12/02/2019

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