MEDICARE: COLUMBUS CLINIC, P.C.

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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1609863133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS CLINIC, P.C.

Provider Business Mailing Address
First Line	:	610 19TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1528
Country	:	US
Telephone Number	:	706-322-7884
Fax Number	:	706-660-2118

Provider Business Practice Location Address
First Line	:	610 19TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1528
Country	:	US
Telephone Number	:	706-322-7884
Fax Number	:	706-660-2118

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAMES S. ZACHARIAS
Credential	:
Telephone Number	:	706-660-2185

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	11/10/2010

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