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NPI Code Detail

MEDICARE: CSRA PEDIATRICS

MEDICARE: CSRA PEDIATRICS
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
1173000000XLegal Medicine054398GA
2173000000XLegal Medicine038178GA
3173000000XLegal Medicine052636GA

General Provider Information

NPI Number : 1720031230
Entity Type Code : Organization
Provider Name (Legal Business Name) : CSRA PEDIATRICS
Provider Business Mailing Address
First Line : 820 SAINT SEBASTIAN WAY
Second Line : SUITE 1B
City : AUGUSTA
State : GA
Zip : 30901-2643
Country : US
Telephone Number : 706-724-7533
Fax Number : 706-724-1530
Provider Business Practice Location Address
First Line : 820 SAINT SEBASTIAN WAY
Second Line : SUITE 1B
City : AUGUSTA
State : GA
Zip : 30901-2643
Country : US
Telephone Number : 706-724-7533
Fax Number : 706-724-1530
Authorized Official
Title or Position : MANAGER
Name : MRS. ROBYN J MORRIS
Credential :
Telephone Number : 706-724-7533
Provider Enumeration Date : 05/18/2006
Last Update Date : 08/22/2020

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Directions to “CSRA PEDIATRICS ” Practice Location

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