Provider Demographics
NPI:1619269552
Name:PHOEBE FAMILY MEDICAL ALBANY
Entity Type:Organization
Organization Name:PHOEBE FAMILY MEDICAL ALBANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP PHYSICIAN PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-446-1990
Mailing Address - Street 1:808 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1328
Mailing Address - Country:US
Mailing Address - Phone:229-883-1208
Mailing Address - Fax:229-883-4363
Practice Address - Street 1:808 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1328
Practice Address - Country:US
Practice Address - Phone:229-883-1208
Practice Address - Fax:229-883-4363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOEBE PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-11
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center