Provider Demographics
NPI:1619110574
Name:ADVANCED GYNECOLOGY SPECIALISTS OF AUGUSTA
Entity Type:Organization
Organization Name:ADVANCED GYNECOLOGY SPECIALISTS OF AUGUSTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:THAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-922-4545
Mailing Address - Street 1:7013 EVANS TOWN CENTER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5117
Mailing Address - Country:US
Mailing Address - Phone:706-922-4545
Mailing Address - Fax:
Practice Address - Street 1:7013 EVANS TOWN CENTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5117
Practice Address - Country:US
Practice Address - Phone:706-922-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16291207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30996Medicare UPIN