Provider Demographics
NPI:1245478049
Name:WARNER ROBINS INTERNAL MEDICINE & GERIATRICS, LLC
Entity type:Organization
Organization Name:WARNER ROBINS INTERNAL MEDICINE & GERIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-225-9001
Mailing Address - Street 1:1654 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3439
Mailing Address - Country:US
Mailing Address - Phone:478-225-9001
Mailing Address - Fax:478-225-9167
Practice Address - Street 1:1654 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3439
Practice Address - Country:US
Practice Address - Phone:478-225-9001
Practice Address - Fax:478-225-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061665207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA726255782AMedicaid
GAH92402Medicare PIN