Provider Demographics
NPI:1356709935
Name:GEORGIA REGENTS UNIVERSITY AUGUSTA
Entity type:Organization
Organization Name:GEORGIA REGENTS UNIVERSITY AUGUSTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN, MEDICAL COLLEGE OF GEORGIA
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-721-2231
Mailing Address - Street 1:1040 ALEXANDER DR
Mailing Address - Street 2:APT 5222
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0243
Mailing Address - Country:US
Mailing Address - Phone:706-288-6835
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:SUITE BP 4109
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008180282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital