Individual
DR. TAKIA MARCELLUS OGLESBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7351 OLD MOON RD, COLUMBUS, GA 31909-7291
(706) 653-7000
(706) 653-7800
Mailing address
7351 OLD MOON RD, COLUMBUS, GA 31909-7291
(706) 653-7000
(706) 653-7800
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
063107
GA
208VP0014X
Interventional Pain Medicine Physician
Primary
063107
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008131896A
—
GA
01
—
202I728681
MEDICARE PTAN
GA
Enumeration date
04/19/2007
Last updated
09/17/2014
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