Provider Demographics
NPI:1154475085
Name:DOUGLAS MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:DOUGLAS MEDICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-384-3338
Mailing Address - Street 1:200 DOCTORS DR STE 106
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2202
Mailing Address - Country:US
Mailing Address - Phone:912-384-3338
Mailing Address - Fax:912-383-6365
Practice Address - Street 1:200 DOCTORS DR STE 106
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2202
Practice Address - Country:US
Practice Address - Phone:912-384-3338
Practice Address - Fax:912-383-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038423207R00000X
GA053749207R00000X
GA056658207R00000X
GA024996207RC0000X
GARN101998363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI39987Medicare UPIN
GAF43543Medicare UPIN
GAP28327Medicare UPIN
GAF23558Medicare UPIN
GAG29391Medicare UPIN