Provider Demographics
NPI:1649349978
Name:AUGUSTA DERMATOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:AUGUSTA DERMATOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-722-4280
Mailing Address - Street 1:820 ST SEBASTIAN WAY STE 6C
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-722-4280
Mailing Address - Fax:706-722-4298
Practice Address - Street 1:820 ST SEBASTIAN WAY STE 6C
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-722-4280
Practice Address - Fax:706-722-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP484Medicare ID - Type Unspecified