Provider Demographics
NPI:1073768537
Name:COLUMBUS MEDICAL SERVICES
Entity type:Organization
Organization Name:COLUMBUS MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-916-1091
Mailing Address - Street 1:2250 CORPORATE PLAZA PKWY SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2969
Mailing Address - Country:US
Mailing Address - Phone:770-916-1091
Mailing Address - Fax:770-916-1120
Practice Address - Street 1:235 W ROOSEVELT AVE
Practice Address - Street 2:SUITE 251
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2640
Practice Address - Country:US
Practice Address - Phone:229-435-3212
Practice Address - Fax:229-435-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000979052EMedicaid