Provider Demographics
NPI:1841202876
Name:JEFFREY RYMUZA, MD PC
Entity type:Organization
Organization Name:JEFFREY RYMUZA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:RYMUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-923-5786
Mailing Address - Street 1:PO BOX 7617
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-7617
Mailing Address - Country:US
Mailing Address - Phone:478-923-5786
Mailing Address - Fax:478-329-8820
Practice Address - Street 1:1554 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3432
Practice Address - Country:US
Practice Address - Phone:478-923-5786
Practice Address - Fax:478-329-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031112207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000377242AMedicaid
GAC81527Medicare UPIN
GA000377242AMedicaid