Organization
MIDDLE GEORGIA FAMILY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J RENNER M.D. (OWNER/PHYSICIAN)
(478) 329-0291
Entity
Organization
Contact information
Practice address
306 CORDER ROAD, STE 2, WARNER ROBINS, GA 31088
(478) 329-0291
(478) 329-1579
Mailing address
306 CORDER ROAD, STE 2, WARNER ROBINS, GA 31088
(478) 329-0291
(478) 329-1579
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
038594
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00607626D
—
GA
01
—
392665
BCBS
GA
01
—
GRP4178
MEDICARE GROUP NUMBER
GA
Enumeration date
03/13/2008
Last updated
03/13/2008
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