Provider Demographics
NPI:1689687915
Name:CENTRAL GEORGIA HEALTH CARE CENTER, PC
Entity Type:Organization
Organization Name:CENTRAL GEORGIA HEALTH CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-953-4844
Mailing Address - Street 1:500 SPILLERS WAY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-0513
Mailing Address - Country:US
Mailing Address - Phone:478-953-4844
Mailing Address - Fax:478-953-4824
Practice Address - Street 1:500 SPILLERS WAY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-0513
Practice Address - Country:US
Practice Address - Phone:478-953-4844
Practice Address - Fax:478-953-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7665OtherMEDICARE GROUP NUMBER