Provider Demographics
NPI:1639224801
Name:ENDOCRINE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:ENDOCRINE CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-322-1700
Mailing Address - Street 1:2425 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4501
Mailing Address - Country:US
Mailing Address - Phone:706-322-1700
Mailing Address - Fax:706-320-0456
Practice Address - Street 1:2425 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4501
Practice Address - Country:US
Practice Address - Phone:706-322-1700
Practice Address - Fax:706-320-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040452174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00665915AMedicaid
GA46BBBHWMedicare ID - Type Unspecified
GA46BBBDBMedicare ID - Type Unspecified
GAE77876Medicare UPIN
GA00665915AMedicaid
GAB05196Medicare UPIN