Healthcare Provider Details

I. General information

NPI: 1801825104
Provider Name (Legal Business Name): OBGYN PARTNERS OF AUGUSTA, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY SUITE 4100
AUGUSTA GA
30901
US

IV. Provider business mailing address

1348 WALTON WAY SUITE 4100
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-1381
  • Fax: 706-823-6871
Mailing address:
  • Phone: 706-722-1381
  • Fax: 706-823-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number207V00000X
License Number StateGA

VIII. Authorized Official

Name: MICHAEL DUCKWORTH
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 706-722-1381