Provider Demographics
NPI:1578624367
Name:UROLOGICAL HEALTH CENTER, PC
Entity Type:Organization
Organization Name:UROLOGICAL HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-271-4630
Mailing Address - Street 1:PO BOX 5098
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-5098
Mailing Address - Country:US
Mailing Address - Phone:229-271-4630
Mailing Address - Fax:
Practice Address - Street 1:906 N 5TH ST
Practice Address - Street 2:STE D
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3200
Practice Address - Country:US
Practice Address - Phone:229-271-4630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA162941944FMedicaid
GA162941944HMedicaid
GAGRP6477Medicare PIN