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General NPI Number Information
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NPI Number | 1134164452
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Entity Type | Organization
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Legal Business Name | SATILLA FAMILY MEDICINE, P.C.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 407 W ONEIDA ST
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City | WAYCROSS
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State | GA
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Zip | 31501-5320
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Country | US
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Telephone | 912-338-0065
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Fax | 912-338-0920
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Provider Business Mailing Address
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Address Line | 407 W ONEIDA ST
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City | WAYCROSS
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State | GA
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Zip | 31501-5320
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Country | US
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Telephone | 912-338-0065
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Fax | 912-338-0920
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MUKESH AGARWAL
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Credential | M.D.
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Telephone | 912-338-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 048327
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 039994
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License Number State | GA
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