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General NPI Number Information
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NPI Number | 1104888403
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Entity Type | Individual
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Provider Name | ABNER H BAGENSTOSE III MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 4830 KNIGHTSBRIDGE BLVD STE C
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City | COLUMBUS
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State | OH
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Zip | 43214-2300
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Country | US
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Telephone | 614-459-4949
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Fax | 614-459-4951
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Provider Business Mailing Address
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Address Line | 5223 PAULSEN ST
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City | SAVANNAH
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State | GA
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Zip | 31405-4700
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Country | US
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Telephone | 912-303-9355
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 35037450B
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License Number State | OH
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