Provider Demographics
NPI:1457879306
Name:BROOKSTONE RHEUMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:BROOKSTONE RHEUMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-643-0996
Mailing Address - Street 1:2443 BROOKSTONE CENTRE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4664
Mailing Address - Country:US
Mailing Address - Phone:706-221-2768
Mailing Address - Fax:706-221-1908
Practice Address - Street 1:2443 BROOKSTONE CENTRE PKWY STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4664
Practice Address - Country:US
Practice Address - Phone:706-320-8900
Practice Address - Fax:706-320-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062935261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4918817Medicaid