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General NPI Number Information
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NPI Number | 1619110574
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Entity Type | Organization
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Legal Business Name | ADVANCED GYNECOLOGY SPECIALISTS OF AUGUSTA
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 7013 EVANS TOWN CENTER BLVD SUITE 101
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City | EVANS
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State | GA
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Zip | 30809-5117
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Country | US
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Telephone | 706-922-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 7013 EVANS TOWN CENTER BLVD SUITE 101
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City | EVANS
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State | GA
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Zip | 30809-5117
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Country | US
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Telephone | 706-922-4545
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PAUL M THAXTON
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Credential | M.D.
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Telephone | 706-922-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 16291
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License Number State | GA
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