Individual
JERRY AMBROSIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 MANCHESTER EXPY, STE 101A, COLUMBUS, GA 31904-6802
(706) 322-6646
(706) 322-2891
Mailing address
PO BOX 7217, COLUMBUS, GA 31908-7217
(706) 322-6646
(706) 322-2891
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
074247
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003161557A
—
GA
Enumeration date
06/09/2010
Last updated
07/10/2015
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