Healthcare Provider Details

I. General information

NPI: 1932398831
Provider Name (Legal Business Name): REPRODUCTIVE ENDOCRINOLOGISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 15TH ST
AUGUSTA GA
30901-2607
US

IV. Provider business mailing address

903 15TH ST
AUGUSTA GA
30901-2607
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-8878
  • Fax: 706-724-3796
Mailing address:
  • Phone: 706-724-8878
  • Fax: 706-724-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number08531
License Number StateGA

VIII. Authorized Official

Name: BHUVANA NATRAJAN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 706-724-8878