Healthcare Provider Details

I. General information

NPI: 1881370856
Provider Name (Legal Business Name): EMILY ANN BOUFFINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 HARPER STREET
AUGUSTA GA
30912
US

IV. Provider business mailing address

4188 CANDLEBERRY GARDEN
NORTH AUGUSTA SC
29860
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-5437
  • Fax:
Mailing address:
  • Phone: 985-502-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15159
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: