MEDICARE: MCGH-PPG REPRODUCTIVE LAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52848388-001	OTHER	GA	BCBSGA ID NUMBER

General Provider Information

NPI Number	:	1568402345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCGH-PPG REPRODUCTIVE LAB, LLC

Provider Business Mailing Address
First Line	:	907 15TH ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2607
Country	:	US
Telephone Number	:	706-724-2707
Fax Number	:	706-722-4490

Provider Business Practice Location Address
First Line	:	907 15TH ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2607
Country	:	US
Telephone Number	:	706-724-2707
Fax Number	:	706-722-4490

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	CURT M. STEINHART
Credential	:	M.D.
Telephone Number	:	706-828-6400

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/22/2020

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