Provider Demographics
NPI:1013352681
Name:PERRY INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:PERRY INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-988-0022
Mailing Address - Street 1:1013 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3353
Mailing Address - Country:US
Mailing Address - Phone:478-988-0022
Mailing Address - Fax:478-987-0444
Practice Address - Street 1:1013 MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3353
Practice Address - Country:US
Practice Address - Phone:478-988-0022
Practice Address - Fax:478-987-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137350AMedicaid
GA202G705702OtherMEDICARE