Provider Demographics
NPI:1225372329
Name:WARNER ROBINS MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:WARNER ROBINS MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYATRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-333-6977
Mailing Address - Street 1:623 S HOUSTON LAKE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9093
Mailing Address - Country:US
Mailing Address - Phone:478-333-6977
Mailing Address - Fax:478-333-6973
Practice Address - Street 1:623 S HOUSTON LAKE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9093
Practice Address - Country:US
Practice Address - Phone:478-333-6977
Practice Address - Fax:478-333-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47262207R00000X
GA049458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCDMTMedicare PIN
GAH00264Medicare UPIN
GA11BDWXKMedicare PIN
GAH15603Medicare UPIN