Provider Demographics
NPI:1497816094
Name:GENERAL SURGERY & ONCOLOGY ASSOCIATES OF AUGUSTA, P.C.
Entity Type:Organization
Organization Name:GENERAL SURGERY & ONCOLOGY ASSOCIATES OF AUGUSTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-868-5057
Mailing Address - Street 1:3623 J DEWEY GRAY CIRCLE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6595
Mailing Address - Country:US
Mailing Address - Phone:706-868-5057
Mailing Address - Fax:706-855-1244
Practice Address - Street 1:3623 J DEWEY GRAY CIRCLE
Practice Address - Street 2:SUITE 101
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6595
Practice Address - Country:US
Practice Address - Phone:706-868-5057
Practice Address - Fax:706-855-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019942208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGAP021Medicaid
GAGRP662Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER