Provider Demographics
NPI:1508931825
Name:NESBIT, DOUGLAS HAMILTON (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HAMILTON
Last Name:NESBIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 AUGUSTA WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1854
Mailing Address - Country:US
Mailing Address - Phone:706-868-0380
Mailing Address - Fax:706-868-1163
Practice Address - Street 1:1230 AUGUSTA WEST PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1854
Practice Address - Country:US
Practice Address - Phone:706-868-0380
Practice Address - Fax:706-868-1163
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045101208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00831597DMedicaid