Provider Demographics
NPI:1164692786
Name:CSRA INTERNAL MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:CSRA INTERNAL MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STULBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-868-9797
Mailing Address - Street 1:1109 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6633
Mailing Address - Country:US
Mailing Address - Phone:706-868-9797
Mailing Address - Fax:706-868-9820
Practice Address - Street 1:1109 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6633
Practice Address - Country:US
Practice Address - Phone:706-868-9797
Practice Address - Fax:706-868-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028656173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP80Medicare PIN