MEDICARE: SOUTH COLUMBUS FAMILY PRACTICE

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	036581	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	:	1659592137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COLUMBUS FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	4000 SAINT MARYS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7626
Country	:	US
Telephone Number	:	706-685-2770
Fax Number	:	706-685-3299

Provider Business Practice Location Address
First Line	:	4000 SAINT MARYS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7626
Country	:	US
Telephone Number	:	706-685-2770
Fax Number	:	706-685-3299

Authorized Official
Title or Position	:	MD
Name	:	SHABBIR MOTIWALA
Credential	:
Telephone Number	:	706-685-2770

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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