Healthcare Provider Details

I. General information

NPI: 1033186358
Provider Name (Legal Business Name): JUAN L COLON-SANTINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 J DEWEY GRAY CIRCLE SUITE 300
AUGUSTA GA
30909-1868
US

IV. Provider business mailing address

PO BOX 3726
AUGUSTA GA
30914-3726
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-9595
  • Fax: 888-745-3917
Mailing address:
  • Phone: 706-863-9595
  • Fax: 888-745-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033056
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: