Healthcare Provider Details

I. General information

NPI: 1629138698
Provider Name (Legal Business Name): ANDREW WILLIAM TORRANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N BELAIR RD STE 2B
EVANS GA
30809-3190
US

IV. Provider business mailing address

1706 MAGNOLIA WAY
AUGUSTA GA
30909-9481
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-7400
  • Fax:
Mailing address:
  • Phone: 706-210-7529
  • Fax: 706-312-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD34333
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number62086
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62086
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: