MEDICARE: MR. DENNIS JAMES SHORT JR. P.A.

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	363AM0700X	Medical Physician Assistant	1463	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1619051455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS JAMES SHORT JR. P.A.

Provider Business Mailing Address
First Line	:	1942 NORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1525
Country	:	US
Telephone Number	:	706-596-1245
Fax Number	:	706-576-4245

Provider Business Practice Location Address
First Line	:	1942 NORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1525
Country	:	US
Telephone Number	:	706-596-1245
Fax Number	:	706-576-4245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/21/2011

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