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General NPI Number Information
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NPI Number | 1770865396
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Entity Type | Organization
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Legal Business Name | FALCON MEDICAL GROUP
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Dates
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Enumeration Date | 09/10/2011
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 1301 BROAD ST SUITE 102
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City | AUGUSTA
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State | GA
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Zip | 30901-1055
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Country | US
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Telephone | 706-723-5894
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12308
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City | AUGUSTA
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State | GA
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Zip | 30914-2308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | MR. CHRISTOPHER SCOTT JACKSON
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Credential |
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Telephone | 706-951-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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