Provider Demographics
NPI:1033716139
Name:PHYSICIAN CONSULTANTS OF GEORGIA WARNER ROBINS LLC
Entity Type:Organization
Organization Name:PHYSICIAN CONSULTANTS OF GEORGIA WARNER ROBINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:478-972-4467
Mailing Address - Street 1:PO BOX 6612
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6612
Mailing Address - Country:US
Mailing Address - Phone:478-250-1325
Mailing Address - Fax:478-254-6860
Practice Address - Street 1:1570 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3474
Practice Address - Country:US
Practice Address - Phone:478-250-1325
Practice Address - Fax:478-254-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty