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Contact Information

DOUGLAS MEDICAL SPECIALIST
134 E FLEETWOOD AVE
WILLACOOCHEE, GA31650
 Phone: 912-384-3338
 Fax: 912-383-6365
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for DOUGLAS MEDICAL SPECIALIST

NPI Number 1114114055
LBN Legal business name DOUGLAS MEDICAL SPECIALIST
Authorized official MARSHALL TANNER - (DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 09/25/2007
Last updated 10/30/2007 - About 19 years ago
Identifiers
GA License # 056658
GA Other 1225021678 NPI
GA Other 1326031865 NPI
GA Other 1750374294 NPI
GA Other 1891815924 NPI
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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