Provider Demographics
NPI:1851504120
Name:COLUMBUS MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:COLUMBUS MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KORNMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:828-894-8213
Mailing Address - Street 1:45 E MILLS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722
Mailing Address - Country:US
Mailing Address - Phone:828-894-8213
Mailing Address - Fax:828-894-5775
Practice Address - Street 1:45 E MILLS ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722
Practice Address - Country:US
Practice Address - Phone:828-894-8213
Practice Address - Fax:828-894-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01347OtherBCBS
NC8901347Medicaid
NC8901347Medicaid