Provider Demographics
NPI:1063818920
Name:AUGUSTA RETINA CONSULTANTS
Entity Type:Organization
Organization Name:AUGUSTA RETINA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-589-5361
Mailing Address - Street 1:1701 MAGNOLIA WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9485
Mailing Address - Country:US
Mailing Address - Phone:706-589-5361
Mailing Address - Fax:
Practice Address - Street 1:1701 MAGNOLIA WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9483
Practice Address - Country:US
Practice Address - Phone:706-589-5361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01149235OtherMEDICARE PTAN
GA202G700947Medicare PIN
GA202I841538Medicare PIN