Provider Demographics
NPI:1669543815
Name:INPHYNET PRIMARY CARE PHYSICIAN SOUTHEAST PC - ACUTE CARE EXPRESS
Entity type:Organization
Organization Name:INPHYNET PRIMARY CARE PHYSICIAN SOUTHEAST PC - ACUTE CARE EXPRESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCMICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-424-3672
Mailing Address - Street 1:7901 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1723
Mailing Address - Country:US
Mailing Address - Phone:706-321-1223
Mailing Address - Fax:
Practice Address - Street 1:7901 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1723
Practice Address - Country:US
Practice Address - Phone:706-321-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3624Medicare ID - Type Unspecified