Provider Demographics
NPI:1902250434
Name:PHOEBE PHYSICIAN GROUP, INC
Entity Type:Organization
Organization Name:PHOEBE PHYSICIAN GROUP, INC
Other - Org Name:PHOEBE FUNCTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-312-6721
Mailing Address - Street 1:500 W 3RD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1985
Mailing Address - Country:US
Mailing Address - Phone:229-312-5800
Mailing Address - Fax:
Practice Address - Street 1:311 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2093
Practice Address - Country:US
Practice Address - Phone:229-312-2200
Practice Address - Fax:229-312-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty