Healthcare Provider Details

I. General information

NPI: 1760833933
Provider Name (Legal Business Name): ADRIAN NICOLAS AVILA HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

69 LAFAYETTE ST
NORTH AUGUSTA SC
29841-3954
US

V. Phone/Fax

Practice location:
  • Phone: 706-726-7490
  • Fax:
Mailing address:
  • Phone: 706-726-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number008737
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number67069
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: