Provider Demographics
NPI: | 1184679482 |
---|---|
Name: | HEALTH SERVICES OF CENTRAL GEORGIA |
Entity Type: | Organization |
Organization Name: | HEALTH SERVICES OF CENTRAL GEORGIA |
Other - Org Name: | NAVICENT HEALTH PHYSICIAN GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIMBERLY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHREWSBURY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 478-633-1452 |
Mailing Address - Street 1: | 2490 RIVERSIDE DR |
Mailing Address - Street 2: | STE B |
Mailing Address - City: | MACON |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31204-1750 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 478-633-6713 |
Mailing Address - Fax: | 478-633-5384 |
Practice Address - Street 1: | 777 HEMLOCK ST |
Practice Address - Street 2: | |
Practice Address - City: | MACON |
Practice Address - State: | GA |
Practice Address - Zip Code: | 31201-2102 |
Practice Address - Country: | US |
Practice Address - Phone: | 478-633-6713 |
Practice Address - Fax: | 478-633-5384 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-24 |
Last Update Date: | 2023-02-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | Group - Multi-Specialty |
No | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | Group - Multi-Specialty |
No | 2086S0127X | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | GRP3578 | Medicare ID - Type Unspecified | GROUP # |
GA | 300033161A | Medicaid |