Healthcare Provider Details

I. General information

NPI: 1053848184
Provider Name (Legal Business Name): JULIE BETH SIEGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 OLD JEFFERSON RD BLDG 700
ATHENS GA
30607-1465
US

IV. Provider business mailing address

3320 OLD JEFFERSON RD BLDG 700
ATHENS GA
30607-1465
US

V. Phone/Fax

Practice location:
  • Phone: 706-715-2430
  • Fax: 762-316-2115
Mailing address:
  • Phone: 706-353-2990
  • Fax: 706-353-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL40935
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number112934
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number59420
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number112934
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: