MEDICARE: MITHILESH SIDDU

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
1	2084V0102X	Vascular Neurology Physician	83992	GA
2	2084N0400X	Neurology Physician	83992	GA

General Provider Information

NPI Number	:	1174907521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITHILESH SIDDU

Provider Business Mailing Address
First Line	:	409 POTTERY DR
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-9295
Country	:	US
Telephone Number	:	425-894-7315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 15TH ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30912-3201
Country	:	US
Telephone Number	:	706-721-1962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	06/20/2023

Similar Medicare Providers

1306849658 — DR. STUART D. MARKS M.D.
Practice Location Address:

905 STEVENS CREEK RD
AUGUSTA, GA
30907-3201

Practice Phone: 706-922-6000
Practice Fax: 706-722-7994

1225086721 — AUGUSTA EYE MD, PC
Practice Location Address:

905 STEVENS CREEK RD STE A
AUGUSTA, GA
30907-3201

Practice Phone: 706-922-6000
Practice Fax: 706-722-7994

1154449643 — AUGUSTA EYE SURGERY, LLC
Practice Location Address:

905 STEVENS CREEK RD
AUGUSTA, GA
30907-3201

Practice Phone: 706-922-6000
Practice Fax: 706-722-7994

1518216290 — MRS. QUINICKA BRYANT-GHANT MSW, BCBA
Practice Location Address:

1237 AUGUSTA AVE
AUGUSTA, GA
30901-3201

Practice Phone: 762-685-4340
Practice Fax: 762-585-9965

1356706709 — SOUTHERN ANESTHESIA OF AUGUSTA LLC
Practice Location Address:

905 STEVENS CREEK RD
AUGUSTA, GA
30907-3201

Practice Phone: 706-922-6000
Practice Fax: 706-722-7994

1679924542 — DR. JARED STAATS OD
Practice Location Address:

905 STEVENS CREEK RD
AUGUSTA, GA
30907-3201

Practice Phone: 706-922-6000
Practice Fax:

Directions to “ MITHILESH SIDDU ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.