Provider Demographics
NPI:1619089653
Name:SOUTH HOUSTON INTERNAL MEDICINE
Entity Type:Organization
Organization Name:SOUTH HOUSTON INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LOMBOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-987-7444
Mailing Address - Street 1:1018 KEITH DR
Mailing Address - Street 2:STE A
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2947
Mailing Address - Country:US
Mailing Address - Phone:478-987-7444
Mailing Address - Fax:478-987-7422
Practice Address - Street 1:1018 KEITH DR
Practice Address - Street 2:SUITE A
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069
Practice Address - Country:US
Practice Address - Phone:478-987-7444
Practice Address - Fax:478-987-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty