Healthcare Provider Details

I. General information

NPI: 1124053228
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF AUGUSTA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST STE 20
AUGUSTA GA
30901
US

IV. Provider business mailing address

811 13TH ST STE 20
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-3401
  • Fax: 706-724-6540
Mailing address:
  • Phone: 706-722-3401
  • Fax: 706-724-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SINDI S AZAR
Title or Position: BUSINESS MANAGER
Credential:
Phone: 706-722-3401