Healthcare Provider Details

I. General information

NPI: 1508931825
Provider Name (Legal Business Name): DOUGLAS HAMILTON NESBIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1854
US

IV. Provider business mailing address

1230 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1854
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-0380
  • Fax: 706-868-1163
Mailing address:
  • Phone: 706-868-0380
  • Fax: 706-868-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: