Healthcare Provider Details

I. General information

NPI: 1023049681
Provider Name (Legal Business Name): JOSHUA ROBERT PACUT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8816 US HIGHWAY 301
CLAXTON GA
30417-5428
US

IV. Provider business mailing address

178 CROSSWINDS DR
RICHMOND HILL GA
31324-5398
US

V. Phone/Fax

Practice location:
  • Phone: 912-739-3019
  • Fax:
Mailing address:
  • Phone: 912-756-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: