Healthcare Provider Details

I. General information

NPI: 1033105416
Provider Name (Legal Business Name): EVAN C BAHR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WRIGHTSBORO RD
AUGUSTA GA
30904-6220
US

IV. Provider business mailing address

2300 WRIGHTSBORO RD
AUGUSTA GA
30904-6220
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-3948
  • Fax: 706-737-4035
Mailing address:
  • Phone: 706-737-3948
  • Fax: 706-737-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number037131
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: