Healthcare Provider Details

I. General information

NPI: 1609024926
Provider Name (Legal Business Name): AMY M SPRAGUE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

PO BOX 211550
AUGUSTA GA
30917-1550
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-9860
  • Fax: 888-743-0249
Mailing address:
  • Phone: 706-855-9860
  • Fax: 888-743-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number035145
License Number StateGA

VIII. Authorized Official

Name: AMY M SPRAGUE
Title or Position: PRESIDENT
Credential: MD
Phone: 706-855-9860