Provider Demographics
NPI:1114034758
Name:CENTRAL GEORGIA INTERNIST
Entity Type:Organization
Organization Name:CENTRAL GEORGIA INTERNIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUFID
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-741-7241
Mailing Address - Street 1:657 HEMLOCK ST
Mailing Address - Street 2:STE 220
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8329
Mailing Address - Country:US
Mailing Address - Phone:478-741-7241
Mailing Address - Fax:
Practice Address - Street 1:657 HEMLOCK ST
Practice Address - Street 2:STE 220
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8329
Practice Address - Country:US
Practice Address - Phone:478-741-7241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty