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NPI Code Detail

MEDICARE: MARY KATHRYN BOGGS D.O.

MEDICARE: MARY KATHRYN BOGGS D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0102XSurgical Critical Care Physician80269GA
2208600000XSurgery Physician80269GA

General Provider Information

NPI Number : 1033389218
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHRYN BOGGS D.O.
Provider Business Mailing Address
First Line : PO BOX 3548
Second Line :
City : AUGUSTA
State : GA
Zip : 30914-3548
Country : US
Telephone Number : 706-863-9595
Fax Number : 706-868-8375
Provider Business Practice Location Address
First Line : 3647 J DEWEY GRAY CIR STE 200
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-2205
Country : US
Telephone Number : 706-504-9712
Fax Number : 706-504-9703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2008
Last Update Date : 07/29/2019

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