Provider Demographics
NPI:1093855215
Name:JAMES M. DORCHAK, MD, PC
Entity Type:Organization
Organization Name:JAMES M. DORCHAK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN, OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:SANTALIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-596-0078
Mailing Address - Street 1:1538 13TH AVENUE, SUITE B-250
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1950
Mailing Address - Country:US
Mailing Address - Phone:706-596-0078
Mailing Address - Fax:706-596-9915
Practice Address - Street 1:1538 13TH AVENUE, SUITE B-250
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1950
Practice Address - Country:US
Practice Address - Phone:706-596-0078
Practice Address - Fax:706-596-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47587174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG15154Medicare UPIN
GA16BDSZFMedicare ID - Type Unspecified