Provider Demographics
NPI:1487637617
Name:WAXMAN, ERNA ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNA
Middle Name:ANITA
Last Name:WAXMAN
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 1:1126 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1810
Mailing Address - Country:US
Mailing Address - Phone:706-863-5082
Mailing Address - Fax:706-863-4082
Practice Address - Street 1:1126 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1810
Practice Address - Country:US
Practice Address - Phone:706-863-5082
Practice Address - Fax:706-863-4082
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00786959AMedicaid
GAG67301Medicare UPIN