Provider Demographics
NPI:1851400873
Name:MUNROE, JANET A (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:A
Last Name:MUNROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:A
Other - Last Name:MUNROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:1499 WALTON WAY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:AX
Mailing Address - Phone:706-828-6416
Mailing Address - Fax:706-722-7235
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-9729
Practice Address - Fax:706-721-8507
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0442102085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA911577844AMedicaid
SCG44210Medicaid
GA30BDMHKMedicare ID - Type UnspecifiedGA MEDICARE #
SCG44210Medicaid