Provider Demographics
NPI:1245377662
Name:ROYSTON MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:ROYSTON MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ROYSTON MEDICAL ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:706-245-6177
Mailing Address - Street 1:819 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-4434
Mailing Address - Country:US
Mailing Address - Phone:706-245-6177
Mailing Address - Fax:706-245-6242
Practice Address - Street 1:819 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-4434
Practice Address - Country:US
Practice Address - Phone:706-245-6177
Practice Address - Fax:706-245-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1906Medicare UPIN