Organization
PHYSICIAN SUPPORT ASSOCIATES PC
Active
Other names
PHYSICIAN SUPPORT ASSOCIATES INC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ITEOGU PHARMD (PRESIDENT)
(478) 746-2842
Entity
Organization
Contact information
Practice address
1021 DAISY PARK, MACON, GA 31201-2020
(478) 746-2842
(478) 746-8362
Mailing address
1021 DAISY PARK, MACON, GA 31201-2020
(478) 746-2842
(478) 746-8362
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
PHRE006546
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000320251A
—
GA
01
—
1140336
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/15/2006
Last updated
03/14/2013
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