Healthcare Provider Details

I. General information

NPI: 1285727404
Provider Name (Legal Business Name): BRENT HAMMAL LIMBAUGH M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 DANTIGNAC ST STE 1000
AUGUSTA GA
30901-2776
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 706-821-2944
  • Fax:
Mailing address:
  • Phone: 706-736-1830
  • Fax: 706-737-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number054112
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: