Provider Demographics
NPI:1972317303
Name:PROMAX MEDICAL CENTER LLC
Entity type:Organization
Organization Name:PROMAX MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-718-9799
Mailing Address - Street 1:305 PINEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-4486
Mailing Address - Country:US
Mailing Address - Phone:706-718-9799
Mailing Address - Fax:
Practice Address - Street 1:6367 WHITESVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3275
Practice Address - Country:US
Practice Address - Phone:706-576-9844
Practice Address - Fax:706-576-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty