Healthcare Provider Details

I. General information

NPI: 1437167137
Provider Name (Legal Business Name): NEUROLOGICAL ASSSOCIATE OF AUGUSTA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/22/2021
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 ROY RD
AUGUSTA GA
30909-1812
US

IV. Provider business mailing address

1210 ROY ROAD
AUGUSTA GA
30909
US

V. Phone/Fax

Practice location:
  • Phone: 706-860-6515
  • Fax: 706-396-0055
Mailing address:
  • Phone: 706-860-6515
  • Fax: 706-396-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number024895
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number035269
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS BASHINSKI SHAEFER
Title or Position: TREASURER
Credential: MD
Phone: 706-860-6515