Provider Demographics
NPI:1437459799
Name:COLUMBIA PREMIER UROLOGY PLLC
Entity Type:Organization
Organization Name:COLUMBIA PREMIER UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:FITTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:931-381-4344
Mailing Address - Street 1:1407 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3535
Mailing Address - Country:US
Mailing Address - Phone:931-381-4344
Mailing Address - Fax:931-381-4334
Practice Address - Street 1:1407 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3535
Practice Address - Country:US
Practice Address - Phone:931-381-4344
Practice Address - Fax:931-381-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD4878208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02174Medicare UPIN