Healthcare Provider Details

I. General information

NPI: 1881370856
Provider Name (Legal Business Name): EMILY ANN BOUFFINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 TOWN PARK BLVD
EVANS GA
30809-3487
US

IV. Provider business mailing address

129 CANDLEBERRY DR
NORTH AUGUSTA SC
29860-9425
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-2500
  • Fax: 706-854-2534
Mailing address:
  • Phone: 985-502-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number111369
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15159
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: