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NPI Code Detail

MEDICARE: RIVERTOWN MEDICAL CLINIC

MEDICARE: RIVERTOWN MEDICAL CLINIC
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
1207Q00000XFamily Medicine PhysicianGA032941GA

General Provider Information

NPI Number : 1962516120
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERTOWN MEDICAL CLINIC
Provider Business Mailing Address
First Line : 4328 ARMOUR RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-5204
Country : US
Telephone Number : 706-507-1213
Fax Number : 706-507-1217
Provider Business Practice Location Address
First Line : 4328 ARMOUR RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-5204
Country : US
Telephone Number : 706-507-1213
Fax Number : 706-507-1217
Authorized Official
Title or Position : OWNER/DOCOTR
Name : DR. KEVIN DONALD LOKKESMOE
Credential : M.D.
Telephone Number : 706-507-1213
Provider Enumeration Date : 08/17/2006
Last Update Date : 06/25/2012

Similar Medicare Providers

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1982276952 — MRS. BRIANNA SHEFFIELD APRN
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Directions to “RIVERTOWN MEDICAL CLINIC ” Practice Location

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