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General NPI Number Information
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NPI Number | 1225281330
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Entity Type | Individual
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Provider Name | BOUNTHAVY HOMSOMBATH MD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 3675 J DEWEY GRAY CIR SUITE 300
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City | AUGUSTA
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State | GA
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Zip | 30909-1868
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Country | US
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Telephone | 706-863-9595
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Fax | 888-745-3917
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Provider Business Mailing Address
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Address Line | PO BOX 3726
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City | AUGUSTA
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State | GA
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Zip | 30914-3726
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Country | US
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Telephone | 706-863-9595
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Fax | 888-745-3917
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 68031
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MD0000063863
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | Q6030
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 117401
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MD35525
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 068031
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License Number State | GA
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