Provider Demographics
NPI:1528224524
Name:COLUMBUS CENTER FOR REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY, LLC
Entity Type:Organization
Organization Name:COLUMBUS CENTER FOR REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-653-6344
Mailing Address - Street 1:2323 WHITTLESEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3011
Mailing Address - Country:US
Mailing Address - Phone:706-653-6344
Mailing Address - Fax:706-653-8933
Practice Address - Street 1:2323 WHITTLESEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3011
Practice Address - Country:US
Practice Address - Phone:706-653-6344
Practice Address - Fax:706-653-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BDTBCMedicare UPIN