Provider Demographics
NPI:1932226693
Name:RIVERTOWN MEDICAL CLINIC
Entity type:Organization
Organization Name:RIVERTOWN MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-507-1213
Mailing Address - Street 1:4328 ARMOUR RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5204
Mailing Address - Country:US
Mailing Address - Phone:706-507-1213
Mailing Address - Fax:706-507-1217
Practice Address - Street 1:4328 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5204
Practice Address - Country:US
Practice Address - Phone:706-507-1213
Practice Address - Fax:706-507-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA032941261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF27228Medicare UPIN
GA08BBXDZMedicare ID - Type Unspecified