Healthcare Provider Details

I. General information

NPI: 1598843781
Provider Name (Legal Business Name): CONTRACT PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/14/2012
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 31258
AUGUSTA GA
30903-3058
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-7365
  • Fax: 706-828-2389
Mailing address:
  • Phone: 706-828-2374
  • Fax: 706-828-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MISS JULIE DEASON
Title or Position: DIRECTOR
Credential:
Phone: 706-774-8326