1912951963 NPI number — DOCTORS HOSPITAL OF AUGUSTA LLC

Table of content: (NPI 1912951963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912951963 NPI number — DOCTORS HOSPITAL OF AUGUSTA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS HOSPITAL OF AUGUSTA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912951963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3651 WHEELER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30909-6521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-651-3232
Provider Business Mailing Address Fax Number:
706-651-2041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3651 WHEELER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30909-6521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-651-3232
Provider Business Practice Location Address Fax Number:
706-651-2041
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
706-651-6108

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1757641 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 356425 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220545 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807214700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 358867 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191815 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174493000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: HOS0177N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02718918 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156164500 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 191815 . This is a "WELLCARE HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 91401739 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92844500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 7221 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00000558A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0044555 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1100177 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 912601 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP30784 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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