Healthcare Provider Details

I. General information

NPI: 1376520148
Provider Name (Legal Business Name): DAVID RONALD SQUIRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-1830
  • Fax: 706-737-5103
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 Number052835
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number052835
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: