MEDICARE: COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1699240531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 117337
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-7337
Country	:	US
Telephone Number	:	770-801-2500
Fax Number	:	470-271-2895

Provider Business Practice Location Address
First Line	:	1810 STADIUM DR STE 240
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-3179
Country	:	US
Telephone Number	:	334-291-8303
Fax Number	:	334-291-8325

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MS. TEIRRA WALKER
Credential	:
Telephone Number	:	706-494-4300

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	10/26/2021

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