Healthcare Provider Details

I. General information

NPI: 1447175120
Provider Name (Legal Business Name): NEAL ANTHONY PATHARKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORT GORDON 25501 BRAINARD AVE
APO AA
30905
US

IV. Provider business mailing address

340 BARGERON DR
AUGUSTA GA
30909-6762
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124165
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: