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General NPI Number Information
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NPI Number | 1063818920
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Entity Type | Organization
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Legal Business Name | AUGUSTA RETINA CONSULTANTS
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1701 MAGNOLIA WAY SUITE 201
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City | AUGUSTA
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State | GA
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Zip | 30909-9483
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Country | US
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Telephone | 706-589-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 MAGNOLIA WAY
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City | AUGUSTA
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State | GA
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Zip | 30909-9482
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Country | US
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Telephone | 706-589-5361
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SOHAIL KHAN
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Credential | M.D.
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Telephone | 706-589-5361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 61106
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License Number State | GA
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