Provider Demographics
NPI:1205967312
Name:OCCUPATIONAL MEDICINE OF COLUMBUS
Entity type:Organization
Organization Name:OCCUPATIONAL MEDICINE OF COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-221-1600
Mailing Address - Street 1:7301 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2788
Mailing Address - Country:US
Mailing Address - Phone:706-221-1600
Mailing Address - Fax:706-221-1605
Practice Address - Street 1:7301 N LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2788
Practice Address - Country:US
Practice Address - Phone:706-221-1600
Practice Address - Fax:706-221-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028079173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA028079OtherLICENSE #