Provider Demographics
NPI:1245200203
Name:PILCHER, GRACE A (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:PILCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SAINT SEBASTIAN WAY STE 4C
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2638
Mailing Address - Country:US
Mailing Address - Phone:706-774-5995
Mailing Address - Fax:706-774-5996
Practice Address - Street 1:820 SAINT SEBASTIAN WAY STE 4C
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2638
Practice Address - Country:US
Practice Address - Phone:706-774-5995
Practice Address - Fax:706-774-5996
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048515174400000X
GA485152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00905201OtherRAILROAD MEDICARE
GA000859856CMedicaid
SCGA1387Medicaid
GA202I138238Medicare PIN
GAF38582Medicare UPIN