Provider Demographics
NPI:1710389440
Name:MEDICAL ASSOCIATES OF ALBANY, PC
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF ALBANY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-432-1440
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-0505
Mailing Address - Country:US
Mailing Address - Phone:229-432-1440
Mailing Address - Fax:229-889-8263
Practice Address - Street 1:806 14TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1394
Practice Address - Country:US
Practice Address - Phone:229-888-4093
Practice Address - Fax:229-889-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty