Healthcare Provider Details

I. General information

NPI: 1790070126
Provider Name (Legal Business Name): ERIC KOHL RING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-5611
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-821-8000
  • Fax: 706-821-0500
Mailing address:
  • Phone: 706-721-8000
  • Fax: 706-821-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL33761
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number078230
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: