Organization
COOSA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY C SMITH (OFFICE MANAGER)
(706) 238-5465
Entity
Organization
Contact information
Practice address
126 THREE RIVERS DR NE, ROME, GA 30161-4999
(706) 295-0070
(706) 235-1618
Mailing address
126 THREE RIVERS DR NE, ROME, GA 30161-4999
(706) 295-0070
(706) 235-1618
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300029189A
—
GA
05
—
300029189C
—
GA
01
—
CG3794
RAILROAD MEDICARE GROUP#
GA
Enumeration date
05/04/2006
Last updated
07/21/2022
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