Provider Demographics
NPI:1952499014
Name:AUGUSTA OBSTETRICS AND GYNECOLOGY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:AUGUSTA OBSTETRICS AND GYNECOLOGY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:MAURICIO
Authorized Official - Last Name:THOMAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-863-0200
Mailing Address - Street 1:2806 HILLCREEK DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6484
Mailing Address - Country:US
Mailing Address - Phone:706-863-0200
Mailing Address - Fax:706-863-4695
Practice Address - Street 1:2806 HILLCREEK DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6484
Practice Address - Country:US
Practice Address - Phone:706-863-0200
Practice Address - Fax:706-863-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA 805Medicaid
SCGPA 805Medicaid