Provider Demographics
NPI:1962948414
Name:THE MEDICAL CENTER INC. JBACC LOCATION
Entity type:Organization
Organization Name:THE MEDICAL CENTER INC. JBACC LOCATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:706-660-2757
Mailing Address - Street 1:1831 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8915
Mailing Address - Country:US
Mailing Address - Phone:706-321-6600
Mailing Address - Fax:706-321-6695
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8915
Practice Address - Country:US
Practice Address - Phone:706-321-6600
Practice Address - Fax:706-321-6695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHH007938333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FT4098720OtherDEA