Provider Demographics
NPI:1104260462
Name:LIFE CHANGING MISSIONARY BAPTIST
Entity type:Organization
Organization Name:LIFE CHANGING MISSIONARY BAPTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BISHOP/PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:706-575-6090
Mailing Address - Street 1:4605 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-4050
Mailing Address - Country:US
Mailing Address - Phone:706-575-6090
Mailing Address - Fax:706-324-3577
Practice Address - Street 1:4605 LANGDON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-4050
Practice Address - Country:US
Practice Address - Phone:706-575-6090
Practice Address - Fax:706-324-3577
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE CHANGING MISSIONARY BAPTIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable