Provider Demographics
NPI:1952396665
Name:MEDICAL ASSOCIATES OF ALBANY, P.C.
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF ALBANY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE AR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASHBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-889-9367
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-0505
Mailing Address - Country:US
Mailing Address - Phone:229-889-9367
Mailing Address - Fax:229-317-0678
Practice Address - Street 1:101 OAKLAND CROSSING DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-7228
Practice Address - Country:US
Practice Address - Phone:229-432-1440
Practice Address - Fax:229-889-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA085002011GMedicaid
GA300032673AMedicaid
GACD3696OtherRAILROAD MEDICARE GROUP #
GA300032673BMedicaid