Healthcare Provider Details

I. General information

NPI: 1407409022
Provider Name (Legal Business Name): PILCHER PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 W WHEELER PKWY
AUGUSTA GA
30909-1899
US

IV. Provider business mailing address

1219 W WHEELER PKWY
AUGUSTA GA
30909-1899
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-9416
  • Fax: 706-364-5455
Mailing address:
  • Phone: 706-854-9416
  • Fax: 706-364-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELA PILCHER
Title or Position: OWNER
Credential:
Phone: 706-840-4156