Heritage Physician Services, LLC
Organization Active NPI Emergency Medicine Physician · Columbus, GA
NPI 1003321969 · NPPES record last updated Feb 5, 2020
Key facts
- NPI
- 1003321969
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- HERITAGE PHYSICIAN SERVICES, LLC
- Practice address
- 100 Frist CT
Columbus, GA 31909-3578 - Phone
- (706) 494-2100
- NPI assigned
- Dec 13, 2017
- Organization subpart
- No
Authorized official
- Name
- Kim H Larsen
- Title
- Director of Credentialing
- Phone
- (770) 874-5400
Practitioners 186
-
Keith A Blanks, D.O
-
Kayla D Boyt, FNP-C
-
Sevara Bryant, MD
-
Yolanda Latrell Bunkley, NP-C
-
Christopher Lee Cook, N.P.
-
John R Corbin, MD
-
Carissa B Dehner, FNP-BC
-
Ludwika Zenobia Durbin, NP-C, DNP
-
Joel Fahling, MD
-
Jamila Harris, NP
-
Megan D Hershey, M.D.
-
John B Jennette, M.D.
-
Davina Lang, NP
-
Hardik Parekh, M.D.
-
Eric Phillips, MD
-
Afolabi Tiamiyu, MD
-
Emily Willis, FNP
-
Courtney Anne Young, FNP-C
-
Joseph Earl Conklin Jr., M.D.
-
Kensy Jean-Charles, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180509000280 | GA | Part B Supplier - Clinic/Group Practice | 6305100850 |
Receives reassigned benefits from 184 practitioners Practice locations: Columbus, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
100 Frist CT
Columbus, GA 31909-3578
Mailing address
PO Box 22715
Belfast, ME 04915-4478
Phone (770) 874-5400
Other providers in Columbus, GA
- Nicholas Levi Henson
- Leslie Kate Heptinstall
- Olethia Herbert
- Nicholas Thomas Anthony Herga
- Heritage Healthcare
- Kali Hernandez
- Lamia Hernandez
- Marina Hernandez
- Raeann Hernandez
- Shannon Herold
All providers in Columbus, GA · Emergency Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.