Healthcare Provider Details

I. General information

NPI: 1982081436
Provider Name (Legal Business Name): ASHANDA ESDAILLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH STREET
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST # OR6000
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-8623
  • Fax:
Mailing address:
  • Phone: 706-721-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number73461-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number73461-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0100558
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number92365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: