Healthcare Provider Details

I. General information

NPI: 1972599496
Provider Name (Legal Business Name): OKSANA MARIA DEMEDIUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 WALTON WAY EXT
AUGUSTA GA
30909-6605
US

IV. Provider business mailing address

3520 WALTON WAY EXT
AUGUSTA GA
30909-6605
US

V. Phone/Fax

Practice location:
  • Phone: 706-481-9191
  • Fax: 706-481-9197
Mailing address:
  • Phone: 706-481-9191
  • Fax: 706-481-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number039322
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number039322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: