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General NPI Number Information
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NPI Number | 1356072219
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Entity Type | Individual
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Provider Name | AUSTIN THOMAS ISAAC MD, MBA
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Gender | Male
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 1120 15TH ST
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 WRIGHTSBORO RD
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City | AUGUSTA
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State | GA
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Zip | 30904-4761
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Country | US
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Telephone | 678-920-4721
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 13807
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License Number State | GA
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