Basic Information
| Provider Information | |||||||||
| NPI: | 1821074261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHN | ||||||||
| FirstName: | SUNIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8147 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319088147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063202773 | ||||||||
| FaxNumber: | 7065964226 | ||||||||
| Practice Location | |||||||||
| Address1: | 2122 MANCHESTER EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063202773 | ||||||||
| FaxNumber: | 7065954226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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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 | 208M00000X | 38873 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 050530 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 112195 | 05 | AL | MEDICAID | 000959659 | 05 | GA | MEDICAID |