Provider Demographics
NPI:1760094684
Name:INTERNAL MEDICINE AND GERIATRICS OF MIDDLE GEORGIA L.L.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND GERIATRICS OF MIDDLE GEORGIA L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:REAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-923-2678
Mailing Address - Street 1:PO BOX 8537
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8537
Mailing Address - Country:US
Mailing Address - Phone:478-923-2678
Mailing Address - Fax:478-929-4251
Practice Address - Street 1:1743 WATSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3622
Practice Address - Country:US
Practice Address - Phone:478-929-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty