Healthcare Provider Details

I. General information

NPI: 1093804817
Provider Name (Legal Business Name): GEORGE SICH III D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MAGNOLIA DR
AIKEN SC
29803
US

IV. Provider business mailing address

1120 15TH ST STE BI1056
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 803-648-6988
  • Fax: 803-648-6984
Mailing address:
  • Phone: 706-446-5941
  • Fax: 706-721-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number569
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD001182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: