Provider Demographics
NPI:1326603739
Name:FIAGBE, THERESA A (MD,MPH,CIC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:A
Last Name:FIAGBE
Suffix:
Gender:F
Credentials:MD,MPH,CIC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:A
Other - Last Name:FIAGBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,MPH,CIC
Mailing Address - Street 1:997 SEBASTIAN WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:706-721-6699
Mailing Address - Fax:
Practice Address - Street 1:997 SAINT SEBASTIAN WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-7606
Practice Address - Country:US
Practice Address - Phone:706-721-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA152492084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry