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Contact Information

CSRA PEDIATRICS
820 SAINT SEBASTIAN WAY
SUITE 1B
AUGUSTA, GA30901-2643
 Phone: 706-724-7533
 Fax: 706-724-1530
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Legal Medicine

173000000X
Indicates primary specialty

NPI Profile & details for CSRA PEDIATRICS · (Female)

NPI Number 1720031230
Status Active
Credentials
Entity Individual
Enumeration date 05/18/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA License # 038178
  • GA License # 052636
  • GA License # 054398
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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