Healthcare Provider Details

I. General information

NPI: 1073577631
Provider Name (Legal Business Name): ANJALI PRASAD PARISH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANJALI PRASAD MD

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2331
  • Fax: 706-721-7531
Mailing address:
  • Phone: 706-724-6100
  • Fax: 706-724-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number049082
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: