Healthcare Provider Details

I. General information

NPI: 1780599050
Provider Name (Legal Business Name): APOORVA MADEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

986 CALVIN TER
NORTH AUGUSTA SC
29841-2379
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7005
  • Fax:
Mailing address:
  • Phone: 412-852-8708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number113078
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: