Provider Demographics
NPI:1922346162
Name:COLUMBUS PHYSICAL MEDICINE CENTER, INC.
Entity Type:Organization
Organization Name:COLUMBUS PHYSICAL MEDICINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:CODNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-330-1389
Mailing Address - Street 1:118 ENTERPRISE CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9229
Mailing Address - Country:US
Mailing Address - Phone:706-225-7008
Mailing Address - Fax:
Practice Address - Street 1:118 ENTERPRISE CT
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9229
Practice Address - Country:US
Practice Address - Phone:706-225-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I07116Medicare PIN
GA202I503596Medicare PIN
GA202I972320Medicare PIN
GA202I502109Medicare PIN
GA11BDPVPMedicare PIN
GA202I354541Medicare PIN
GA202I017852Medicare PIN