Healthcare Provider Details

I. General information

NPI: 1013026830
Provider Name (Legal Business Name): RAVINDER JERATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CENTRAL AVE SUITE 7
AUGUSTA GA
30904-6717
US

IV. Provider business mailing address

2100 CENTRAL AVE SUITE 7
AUGUSTA GA
30904-6717
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-5378
  • Fax: 706-738-9922
Mailing address:
  • Phone: 706-736-5378
  • Fax: 706-738-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number19957
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number19957
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: