Healthcare Provider Details

I. General information

NPI: 1528167699
Provider Name (Legal Business Name): JULIAN J. NUSSBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901-2650
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2020
  • Fax: 706-721-1156
Mailing address:
  • Phone: 706-828-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number018936
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number18936
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: