Basic Information
| Provider Information | |||||||||
| NPI: | 1346409927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON INTERNAL MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26040 | ||||||||
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| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312216040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784751299 | ||||||||
| FaxNumber: | 4784057928 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 W ROBERT TOOMBS AVE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306731662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066784785 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 10/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | DODSON | ||||||||
| AuthorizedOfficialFirstName: | KIRKLAND | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7066784785 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 040656 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.