Provider Demographics
NPI:1306952171
Name:UROLOGY ASSOCIATES OF COLUMBUS PC
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES OF COLUMBUS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-323-4000
Mailing Address - Street 1:1538 13TH AVENUE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901
Mailing Address - Country:US
Mailing Address - Phone:706-323-4000
Mailing Address - Fax:706-323-4848
Practice Address - Street 1:1538 13TH AVENUE
Practice Address - Street 2:BUILDING A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-323-4000
Practice Address - Fax:706-323-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3707Medicare ID - Type Unspecified