| Infection Specialists Of Middle Georgia, Llc | |
|
1420 Watson Blvd Warner Robins GA 31093-3446 | |
| (478) 922-5122 | |
| (478) 922-5221 |
| Full Name | Infection Specialists Of Middle Georgia, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1420 Watson Blvd, Warner Robins, Georgia |
| Authorized Official Name and Position | Modupe Oluwatoyin Ogunsakin (OFFICE MANAGER) |
| Authorized Official Contact | 4789225122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infection Specialists Of Middle Georgia, Llc 1420 Watson Blvd Warner Robins GA 31093-3446 Ph: (478) 922-5122 | Infection Specialists Of Middle Georgia, Llc 1420 Watson Blvd Warner Robins GA 31093-3446 Ph: (478) 922-5122 |
| NPI Number | 1700011244 |
|---|---|
| Provider Enumeration Date | 05/28/2009 |
| Last Update Date | 12/04/2009 |
| Medicare PECOS PAC ID | 2961541198 |
|---|---|
| Medicare Enrollment ID | O20091202000029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700011244 | NPI | - | NPPES |
| 721242214A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 55136 (Georgia) | Secondary |
| 207RI0200X | Internal Medicine - Infectious Disease | 55136 (Georgia) | Primary |
| Provider Name | Mobolaji O Ogunsakin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871607226 PECOS PAC ID: 3476528415 Enrollment ID: I20040901000681 |
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