Provider Demographics
NPI:1255454070
Name:MEDICAL COLLEGE OF GEORGIA
Entity type:Organization
Organization Name:MEDICAL COLLEGE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:ARANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-664-1884
Mailing Address - Street 1:623 WALDEN HILLS CIR
Mailing Address - Street 2:623
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0223
Mailing Address - Country:US
Mailing Address - Phone:706-664-1884
Mailing Address - Fax:
Practice Address - Street 1:623 WALDEN HILLS CIR
Practice Address - Street 2:623
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0223
Practice Address - Country:US
Practice Address - Phone:706-664-1884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001189281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital