MEDICARE: MR. SIDNEY AUSTIN GATES JR. LMFT

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	106H00000X	Marriage & Family Therapist	000750	GA

General Provider Information

NPI Number	:	1801944327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIDNEY AUSTIN GATES JR. LMFT

Provider Business Mailing Address
First Line	:	3633 WHEELER RD STE 100
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6550
Country	:	US
Telephone Number	:	706-364-0252
Fax Number	:	706-364-0269

Provider Business Practice Location Address
First Line	:	3633 WHEELER RD
Second Line	:	SUITE 110
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6549
Country	:	US
Telephone Number	:	706-855-7784
Fax Number	:	706-651-1090

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/04/2019

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