Healthcare Provider Details

I. General information

NPI: 1871579250
Provider Name (Legal Business Name): ANDREW EDWARD DOYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WELLSTAR WAY STE 201
HOLLY SPRINGS GA
30114-9086
US

IV. Provider business mailing address

1061 HARMON AVENUE STE 1D03 WINN ARMY COMMUNITY HOSPITAL
FORT STEWART GA
31314-5674
US

V. Phone/Fax

Practice location:
  • Phone: 770-517-1900
  • Fax:
Mailing address:
  • Phone: 912-435-5555
  • Fax: 912-435-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101221487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: