Provider Demographics
NPI:1083171607
Name:COLUMBUS MEMORY CENTER, PC
Entity Type:Organization
Organization Name:COLUMBUS MEMORY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-327-4000
Mailing Address - Street 1:7196 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1693
Mailing Address - Country:US
Mailing Address - Phone:706-327-4000
Mailing Address - Fax:706-324-2557
Practice Address - Street 1:7196 N LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1693
Practice Address - Country:US
Practice Address - Phone:706-327-4000
Practice Address - Fax:706-324-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty