Healthcare Provider Details

I. General information

NPI: 1952486003
Provider Name (Legal Business Name): AUGUSTA PEDIATRIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 WHEELER RD SUITE 302
AUGUSTA GA
30909-1871
US

IV. Provider business mailing address

3540 WHEELER RD SUITE 302
AUGUSTA GA
30909-1871
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-0111
  • Fax: 706-737-0442
Mailing address:
  • Phone: 706-737-0111
  • Fax: 706-737-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DAVID ALLEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 706-737-0111