Provider Demographics
NPI:1316908536
Name:AUGUSTA ORTHOPAEDIC CLINIC PA
Entity type:Organization
Organization Name:AUGUSTA ORTHOPAEDIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-733-1107
Mailing Address - Street 1:1521 ANTHONY RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4821
Mailing Address - Country:US
Mailing Address - Phone:706-733-1107
Mailing Address - Fax:706-733-8449
Practice Address - Street 1:1521 ANTHONY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4821
Practice Address - Country:US
Practice Address - Phone:706-733-1107
Practice Address - Fax:706-733-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA942Medicaid
SCGPA942Medicaid