Provider Demographics
NPI:1417064924
Name:PEDIATRIC PARTNERS OF AUGUSTA, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS OF AUGUSTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:AFFET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-854-2500
Mailing Address - Street 1:PO BOX 1758
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-1758
Mailing Address - Country:US
Mailing Address - Phone:706-854-2500
Mailing Address - Fax:706-854-2559
Practice Address - Street 1:411 TOWN PARK BLVD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3487
Practice Address - Country:US
Practice Address - Phone:706-854-2500
Practice Address - Fax:706-854-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85000031GMedicaid
GA085001130GMedicaid
GA1285831438OtherLAWSON, SARAH
GA1689057440OtherSAFFORD JONES, YOLANDA ROBERTA
GA1770763021OtherCANNADY, WILLIAM EUGENE
GA1841794302OtherJIMENEZ, CHRISTOPHER RYAN
GA1003412248OtherBRITNEY WILKINSON
GA1033734918OtherLAUREN SMITH
GA1194722470OtherCHAPPELL, SCOTT VAUGHAN
GA1780688127OtherBENOIT-HARRIS, DEBBIE
GA1346244795OtherFOUSHEE, KAREN MCGUIGAN
GA1811935414OtherELIZABETH BECTON
GA1982727400OtherJENNIE SCOGGINS
GA85000031GMedicaid
GA085001130GMedicaid
GA1821762337OtherDAKOTA TUCKER
GA1881138592OtherTRACI CORBIN
GA1528181963OtherKITCHENS, JILL WHEELER
GA1740729516OtherLAUREN MATHIS
GA1841777141OtherELISE HARKEY
GA1407850845OtherHERZWURM, SANDRA HUDSON
GA1699932418OtherQUAN JOHNSON
GA1851553515OtherLIGON, JENNIFER AMANDA
GA1356344055OtherBEATRIZ ALEXIA BARRIENTOS
GA1518027457OtherANDERSON, MARY HAMILTON