Healthcare Provider Details

I. General information

NPI: 1285862706
Provider Name (Legal Business Name): CHARLES STEPHENS SCARBOROUGH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 DANTIGNAC ST
AUGUSTA GA
30901-2788
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0600
  • Fax: 706-922-0603
Mailing address:
  • Phone: 706-721-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number67317
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67317
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: