Provider Demographics
NPI:1124016316
Name:EDOUARD J SERVY MD PC
Entity Type:Organization
Organization Name:EDOUARD J SERVY MD PC
Other - Org Name:SERVY INSTITUTE FOR REPRODUCTIVE ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-724-0228
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO16755207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30777Medicare UPIN