Provider Demographics
NPI:1821378076
Name:DOCTORS OF COMPASSIONATE SERVICES
Entity Type:Organization
Organization Name:DOCTORS OF COMPASSIONATE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:FORDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-366-1362
Mailing Address - Street 1:277 LACKAWANNA ST
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-8072
Mailing Address - Country:US
Mailing Address - Phone:912-366-1362
Mailing Address - Fax:912-366-1365
Practice Address - Street 1:277 LACKAWANNA ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513
Practice Address - Country:US
Practice Address - Phone:912-366-1362
Practice Address - Fax:912-366-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty