Provider Demographics
NPI:1154505816
Name:RESURRECTION INSTITUTE FOR BIBLICAL STUDIES
Entity Type:Organization
Organization Name:RESURRECTION INSTITUTE FOR BIBLICAL STUDIES
Other - Org Name:GOLDEN ISLES FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:DOER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-847-4228
Mailing Address - Street 1:1249 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-7729
Mailing Address - Country:US
Mailing Address - Phone:912-427-8031
Mailing Address - Fax:912-427-8032
Practice Address - Street 1:1249 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-7729
Practice Address - Country:US
Practice Address - Phone:912-427-8031
Practice Address - Fax:912-427-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
511G700358OtherGROUP MEDICARE #