Provider Demographics
NPI:1245478213
Name:CHRISTIAN MEDICAL ASSOCIATES OF COLUMBUS, INC.
Entity type:Organization
Organization Name:CHRISTIAN MEDICAL ASSOCIATES OF COLUMBUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOFINTUYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-320-0055
Mailing Address - Street 1:2009 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7931
Mailing Address - Country:US
Mailing Address - Phone:706-320-0055
Mailing Address - Fax:706-576-5133
Practice Address - Street 1:2009 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7931
Practice Address - Country:US
Practice Address - Phone:706-320-0055
Practice Address - Fax:706-576-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA045309207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00802986EMedicaid
GA511G701226Medicare PIN
GA11BDPVPMedicare PIN