Healthcare Provider Details

I. General information

NPI: 1649477993
Provider Name (Legal Business Name): SEAN EUGENE ARBUCKLE SR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

546 GRANDIFLORA CIR.
AIKEN SC
29803
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3052
  • Fax:
Mailing address:
  • Phone: 803-439-8592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number061550
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS11132
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2011033192
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: