Provider Demographics
NPI:1487745899
Name:COLUMBUS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:COLUMBUS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-321-3901
Mailing Address - Street 1:1005 TALBOTTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8757
Mailing Address - Country:US
Mailing Address - Phone:706-321-3901
Mailing Address - Fax:
Practice Address - Street 1:1005 TALBOTTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8757
Practice Address - Country:US
Practice Address - Phone:706-321-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030693302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053082406AMedicaid
GA740587752BMedicaid
GA000368893HMedicaid
GA000368893GMedicaid
GA116901413AMedicaid
GA000368893EMedicaid
GA110180716Medicare PIN
GA110199497Medicare PIN
GA000368893GMedicaid
GA053082406AMedicaid
GA000368893HMedicaid
GA000368893EMedicaid
GACG4979Medicare PIN
GA11BDBPMCMedicare PIN
ALI842Medicare PIN
GA08CBCPTMedicare PIN
AL051538644Medicare PIN