Basic Information
| Provider Information | |||||||||
| NPI: | 1144310954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARMAN | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 COLLEGE ST | ||||||||
| Address2: | A | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312071500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783015801 | ||||||||
| FaxNumber: | 4783015812 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 PINE ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783015801 | ||||||||
| FaxNumber: | 4783015812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 04/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 22755 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 00380179D | 05 | GA | MEDICAID |