Provider Demographics
NPI:1285098970
Name:ANDREA NEITA, DO, PC
Entity type:Organization
Organization Name:ANDREA NEITA, DO, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEITA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-489-0858
Mailing Address - Street 1:3916 MILGEN RD
Mailing Address - Street 2:SUITE 8761
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8761
Mailing Address - Country:US
Mailing Address - Phone:706-984-8885
Mailing Address - Fax:706-984-0580
Practice Address - Street 1:1073 WOODLAND HWY STE B
Practice Address - Street 2:
Practice Address - City:TALBOTTON
Practice Address - State:GA
Practice Address - Zip Code:31827-4549
Practice Address - Country:US
Practice Address - Phone:706-489-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA870227171AMedicaid
GA202G707969Medicare PIN
GAO8CBCPTMedicare UPIN