Provider Demographics
NPI:1124062112
Name:84PEDIATRIX MEDICAL GROUP UNIVERSITY HOSPITAL AUGUSTA GA.
Entity type:Organization
Organization Name:84PEDIATRIX MEDICAL GROUP UNIVERSITY HOSPITAL AUGUSTA GA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURES PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:NNP
Authorized Official - Phone:706-774-8948
Mailing Address - Street 1:4227 QUAIL SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4610
Mailing Address - Country:US
Mailing Address - Phone:706-863-4975
Mailing Address - Fax:
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2629
Practice Address - Country:US
Practice Address - Phone:706-774-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN042192363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty