Provider Demographics
NPI:1144420530
Name:INTERNAL MEDICINE ASSOCIATES OF WAYCROSS, P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF WAYCROSS, P.C.
Other - Org Name:WAYCROSS INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIRENA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-283-9423
Mailing Address - Street 1:711 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-1943
Mailing Address - Country:US
Mailing Address - Phone:912-283-9423
Mailing Address - Fax:912-283-8204
Practice Address - Street 1:711 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1943
Practice Address - Country:US
Practice Address - Phone:912-283-9423
Practice Address - Fax:912-283-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG6045OtherRAILROAD MEDICARE GRP NUM
CG6045OtherRAILROAD MEDICARE GRP NUM