Provider Demographics
NPI:1679089296
Name:CONCIERGE MEDICINE OF COLUMBUS, INC
Entity type:Organization
Organization Name:CONCIERGE MEDICINE OF COLUMBUS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-457-4781
Mailing Address - Street 1:850 BROOKSTONE CENTRE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9245
Mailing Address - Country:US
Mailing Address - Phone:706-507-4242
Mailing Address - Fax:
Practice Address - Street 1:1000 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4675
Practice Address - Country:US
Practice Address - Phone:762-261-3334
Practice Address - Fax:762-261-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty