Provider Demographics
NPI:1366647950
Name:FIRST OPTION MEDICAL
Entity Type:Organization
Organization Name:FIRST OPTION MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHOLIEUS
Authorized Official - Middle Name:S
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-477-0414
Mailing Address - Street 1:3200 RIVERSIDE DRIVE SUITE 250 B
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-477-0414
Mailing Address - Fax:478-477-0415
Practice Address - Street 1:3200 RIVERSIDE DRIVE SUITE 250 B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-477-0414
Practice Address - Fax:478-477-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7014Medicare ID - Type Unspecified