Healthcare Provider Details

I. General information

NPI: 1881520070
Provider Name (Legal Business Name): DHANUSH RAMESH SHIMOGA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 LANEY WALKER BLVD, AE 3040
AUGUSTA GA
30912
US

IV. Provider business mailing address

1469 LANEY WALKER BLVD, AE 3040
AUGUSTA GA
30912
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7005
  • Fax:
Mailing address:
  • Phone: 706-721-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number113850
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: