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1598720617

NPI Code Detail

MEDICARE: DOUGLAS A BOUDREAU MD

MEDICARE: DOUGLAS A BOUDREAU MD

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	208000000X	Pediatrics Physician	90555	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	440546366	OTHER		UNITED HEALTHCARE
2	PC10371	OTHER		CIGNA
3	1724934	OTHER		FIRST HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	H00943	OTHER		MERCY
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	411755	OTHER		HEALTHLINK
8	7609055	OTHER		AETNA
9	124669	OTHER		BLUE CROSS BLUE SHIELD
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598720617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS A BOUDREAU MD

Provider Business Mailing Address
First Line	:	PO BOX 1520
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31310-8520
Country	:	US
Telephone Number	:	912-318-3947
Fax Number	:	912-587-7018

Provider Business Practice Location Address
First Line	:	303 FRASER DR
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-3712
Country	:	US
Telephone Number	:	912-877-2227
Fax Number	:	912-877-2332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	09/20/2023

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Practice Location Address:

303 FRASER DR
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1306332952 — AIYESHA QUANTE STILES APRN
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1972595312 — MRS. SUSAN PATRICE BROWN ANP-C
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1427077759 — MARY JUDITH ALLEN D.O.
Practice Location Address:

303 FRASER DR
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Practice Fax: 912-877-2332

1669481412 — DR. ANDRE MILTON SINGLETON D.D.S.
Practice Location Address:

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1164559571 — MISS NOEMI ADELINA CARCAR MD
Practice Location Address:

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Directions to “ DOUGLAS A BOUDREAU MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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