Provider Demographics
NPI:1043208226
Name:SERVY, EDOUARD JEAN (MD)
Entity Type:Individual
Prefix:MR
First Name:EDOUARD
Middle Name:JEAN
Last Name:SERVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CHAFEE AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5806
Mailing Address - Country:US
Mailing Address - Phone:706-724-0228
Mailing Address - Fax:706-722-2387
Practice Address - Street 1:812 CHAFEE AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5806
Practice Address - Country:US
Practice Address - Phone:706-724-0228
Practice Address - Fax:706-722-2387
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO16755207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30777Medicare UPIN