Provider Demographics
NPI:1699717199
Name:GERIATRICS & FAMILY MEDICINE CENTER OF COLUMBUS, P. C.
Entity type:Organization
Organization Name:GERIATRICS & FAMILY MEDICINE CENTER OF COLUMBUS, P. C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIBIKE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ADEGBILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-256-3500
Mailing Address - Street 1:7196 N LAKE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1693
Mailing Address - Country:US
Mailing Address - Phone:706-256-3500
Mailing Address - Fax:
Practice Address - Street 1:7196 N LAKE DR
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1693
Practice Address - Country:US
Practice Address - Phone:706-256-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048967261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG21270Medicare UPIN