Organization
COLONY MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MYRA D GRIFFIN (OFFICE MANAGER)
(229) 423-2058
Entity
Organization
Contact information
Practice address
110 NORMAN DORMINY DR, SUITE B, FITZGERALD, GA 31750-8858
(229) 423-2058
(229) 423-0197
Mailing address
PO BOX 929, FITZGERALD, GA 31750-0929
(229) 423-2058
(229) 423-0197
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
053043
GA
174400000X
Specialist
056020
GA
174400000X
Specialist
Primary
33123
GA
363LF0000X
Family Nurse Practitioner
RN101986
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00427798A
—
GA
01
—
500002323
RAILROAD MEDICARE
GA
01
—
50BBKJP
MEDICARE
GA
01
—
CB5821
RAILROAD MEDICARE GROUP
GA
01
—
P00232517
RAILROAD MEDICARE
GA
Enumeration date
08/31/2006
Last updated
01/29/2014
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