Healthcare Provider Details

I. General information

NPI: 1700114519
Provider Name (Legal Business Name): KIDS FIRST PEDIATRIC GROUP OF AUGUSTA,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 GEORGE C.WILSON CT. SUITE B1
AUGUSTA GA
30909-5700
US

IV. Provider business mailing address

1215 GEORGE C.WILSON CT. SUITE B1
AUGUSTA GA
30909-5700
US

V. Phone/Fax

Practice location:
  • Phone: 706-650-0004
  • Fax: 706-650-5889
Mailing address:
  • Phone: 706-650-0004
  • Fax: 706-650-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number056931
License Number StateGA

VIII. Authorized Official

Name: CAROL DALE THOMPSON-ARMANT
Title or Position: CEO
Credential: M.D.
Phone: 706-650-0004