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General NPI Number Information
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NPI Number | 1063738722
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Entity Type | Individual
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Provider Name | BERNADETTE T SKRUCK PA
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Gender | Female
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1348 WALTON WAY STE 5700
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City | AUGUSTA
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State | GA
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Zip | 30901-5110
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Country | US
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Telephone | 706-722-8242
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Fax | 706-722-8351
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Provider Business Mailing Address
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Address Line | 2405 PERSIMMON RD
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City | AUGUSTA
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State | GA
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Zip | 30904-3354
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Country | US
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Telephone | 312-927-6634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 6394
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License Number State | GA
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