Organization
INPHYNET PRIMARY CARE PHYSICIANS SOUTHEAST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA LYNN SCANLAN (PROVIDER ENROLLMENT DIRECTOR)
(954) 377-2954
Entity
Organization
Contact information
Practice address
2122 MANCHESTER EXPY, COLUMBUS, GA 31904-6878
(706) 596-4000
Mailing address
PO BOX 636017, CINCINNATI, OH 45263-6017
(800) 424-3672
(954) 377-3042
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169393100
US DEPT OF LABOR
GA
05
—
179928
—
AL
05
—
300041815A
—
GA
05
—
529601690
—
AL
01
—
CG3225
MEDICARE TRAVELERS RR - G
GA
Enumeration date
06/03/2006
Last updated
01/14/2025
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