Provider Demographics
NPI:1861494734
Name:MEJIAS, SERGIO T (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:T
Last Name:MEJIAS
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:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:1500 OGLETHORPE AVE STE 2000
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2188
Practice Address - Country:US
Practice Address - Phone:706-548-5488
Practice Address - Fax:706-548-0016
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40737208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000829628AMedicaid
GA00829628AMedicaid
H00743Medicare UPIN
GAH00743Medicare UPIN
GA000829628AMedicaid