Provider Demographics
NPI:1528201936
Name:ASF MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ASF MEDICAL CENTER INC
Other - Org Name:ASF MEDICAL CENTER RUANTO
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHFAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-468-3373
Mailing Address - Street 1:159 FRANK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-3701
Mailing Address - Country:US
Mailing Address - Phone:229-468-3373
Mailing Address - Fax:229-468-9363
Practice Address - Street 1:640 MAIN ST NORTH
Practice Address - Street 2:
Practice Address - City:PEARSON
Practice Address - State:GA
Practice Address - Zip Code:31642
Practice Address - Country:US
Practice Address - Phone:229-468-3373
Practice Address - Fax:229-468-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19352207P00000X
GA052819207Q00000X
GA044833207R00000X
GA048971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty