Provider Demographics
NPI:1992751911
Name:MIDDLE GEORGIA MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MIDDLE GEORGIA MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CULPEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-923-6633
Mailing Address - Street 1:623 S HOUSTON LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9093
Mailing Address - Country:US
Mailing Address - Phone:478-923-6633
Mailing Address - Fax:478-923-8444
Practice Address - Street 1:623 S HOUSTON LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9093
Practice Address - Country:US
Practice Address - Phone:478-923-6633
Practice Address - Fax:478-923-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047262207R00000X
GA022874207R00000X
GA030052207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2905Medicare ID - Type Unspecified