MEDICARE: GENERAL & VASCULAR SURGERY ASSOCIATES OF AUGUSTA, PC

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	208600000X	Surgery Physician	033948	GA

General Provider Information

NPI Number	:	1578745089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERAL & VASCULAR SURGERY ASSOCIATES OF AUGUSTA, PC

Provider Business Mailing Address
First Line	:	1207 W MEDICAL PARK RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4504
Country	:	US
Telephone Number	:	706-854-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 W MEDICAL PARK RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4504
Country	:	US
Telephone Number	:	706-854-1511
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN COCHRAN
Credential	:	MD
Telephone Number	:	706-854-1511

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/27/2007

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