Provider Demographics
NPI:1942212972
Name:ADVANCED MEDICAL ASSOCIATES P C
Entity type:Organization
Organization Name:ADVANCED MEDICAL ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANILKUMAR
Authorized Official - Middle Name:V
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-922-4010
Mailing Address - Street 1:707 N. HOUSTON RD.
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093
Mailing Address - Country:US
Mailing Address - Phone:478-922-4010
Mailing Address - Fax:478-922-2821
Practice Address - Street 1:707 N. HOUSTON RD.
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093
Practice Address - Country:US
Practice Address - Phone:478-922-4010
Practice Address - Fax:478-922-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85002759GMedicaid
GAGRP3795Medicare PIN
GRP3795Medicare UPIN