# I BASILIO MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356477616
- **Authorized official:** FEODERIS N BASILIO M.D. (PHYSICIAN)
- **Authorized official phone:** (706) 507-5437

## Contact information

- **Practice address:** 2039 WARM SPRINGS RD, COLUMBUS, GA 31904-7931
- **Practice address phone:** (706) 576-5570
- **Mailing address:** 104 14TH ST, COLUMBUS, GA 31901-2131
- **Mailing address phone:** (706) 507-5437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 10/31/2011