Healthcare Provider Details

I. General information

NPI: 1528237955
Provider Name (Legal Business Name): JEREMY B. HERTZA PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HUDSON TRCE
AUGUSTA GA
30907-2010
US

IV. Provider business mailing address

207 HUDSON TRCE
AUGUSTA GA
30907-2010
US

V. Phone/Fax

Practice location:
  • Phone: 706-823-5250
  • Fax: 706-823-5266
Mailing address:
  • Phone: 706-823-5250
  • Fax: 706-823-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY003309
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: