Healthcare Provider Details

I. General information

NPI: 1164468617
Provider Name (Legal Business Name): DEBORAH BATES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

PO BOX 532780
ATLANTA GA
30353-2780
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-1300
  • Fax: 904-805-1302
Mailing address:
  • Phone: 904-805-1300
  • Fax: 904-805-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19367
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: