Healthcare Provider Details

I. General information

NPI: 1598993016
Provider Name (Legal Business Name): ANKUR GOEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 03/07/2023
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 HARPER ST STE B
AUGUSTA GA
30901-0619
US

IV. Provider business mailing address

PO BOX 1705
AUGUSTA GA
30903-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-5451
  • Fax:
Mailing address:
  • Phone: 706-722-2118
  • Fax: 706-722-0342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number073513
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number073513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: