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General NPI Number Information
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NPI Number | 1275593790
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Entity Type | Organization
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Legal Business Name | AUGUSTA PEDIATRIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1245 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1807
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Country | US
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Telephone | 706-868-0389
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Fax | 706-651-0729
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Provider Business Mailing Address
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Address Line | 1245 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1807
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Country | US
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Telephone | 706-868-0389
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Fax | 706-651-0729
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY MILLER JR.
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Credential | M.D.
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Telephone | 706-868-0389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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