Healthcare Provider Details

I. General information

NPI: 1194944645
Provider Name (Legal Business Name): GERARD JULES CHICHE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE GC-1024
AUGUSTA GA
30912-1001
US

IV. Provider business mailing address

1120 15TH ST GC-1024
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-9633
  • Fax: 706-723-0266
Mailing address:
  • Phone: 706-721-9633
  • Fax: 706-723-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4537
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: