Moultrie Urological Clinic, INC
Specialist in Moultrie, GA. Organization (NPI-2).
NPI number1861695579
StatusActive
Last updated in NPPESMar 24, 2010
Details
- NPI
- 1861695579
- Entity type
- Organization (NPI-2)
- Legal business name
- Moultrie Urological Clinic, INC
- Organization subpart
- No
- Enumeration date
- Jun 8, 2007
- Last updated
- Mar 24, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 031557 | GA | Yes |
Practice location
2 Hospital ParkMoultrie, GA 31768-6700
Phone 229-985-3066 · Fax 229-890-2092
Mailing address
2 Hospital ParkMoultrie, GA 31768-6700
Phone 229-985-3066 · Fax 229-890-2092
Authorized official
Maha Kassis Baddour
Practice Manager
2299853066
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