Provider Demographics
NPI:1225301781
Name:MIDDLE GEORGIA INTERNAL MEDICINE & KIDNEY DISEASES
Entity Type:Organization
Organization Name:MIDDLE GEORGIA INTERNAL MEDICINE & KIDNEY DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN-NWOSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-745-8309
Mailing Address - Street 1:1122 GRAY HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1869
Mailing Address - Country:US
Mailing Address - Phone:478-745-8309
Mailing Address - Fax:478-745-8364
Practice Address - Street 1:1122 GRAY HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1869
Practice Address - Country:US
Practice Address - Phone:478-745-8309
Practice Address - Fax:478-745-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33504207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G392211Medicare PIN