Provider Demographics
NPI:1831446905
Name:COLUMBUS CLINIC PC
Entity type:Organization
Organization Name:COLUMBUS CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-243-4404
Mailing Address - Street 1:PO BOX 84052
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-4052
Mailing Address - Country:US
Mailing Address - Phone:706-243-4404
Mailing Address - Fax:
Practice Address - Street 1:705 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3500
Practice Address - Country:US
Practice Address - Phone:706-243-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-08
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000814213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1143820002Medicare NSC