| Douglas A Boudreau, MD | |
|
303 Fraser Dr, Hinesville, GA 31313-3712 | |
| (912) 877-2227 | |
| (912) 877-2332 |
| Full Name | Douglas A Boudreau |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 303 Fraser Dr, Hinesville, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598720617 | NPI | - | NPPES |
| 440546366 | Other | UNITED HEALTHCARE | |
| PC10371 | Other | CIGNA | |
| 1724934 | Other | FIRST HEALTH | |
| 204659403 | Medicaid | MO | |
| H00943 | Other | MERCY | |
| 207515500 | Other | MO | MEDICAID |
| 411755 | Other | HEALTHLINK | |
| 7609055 | Other | AETNA | |
| 124669 | Other | BLUE CROSS BLUE SHIELD | |
| 204659403 | Other | MO | MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 90555 (Georgia) | Primary |
| Entity Name | Capital Region Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1477980837 PECOS PAC ID: 4688573686 Enrollment ID: O20070323000507 |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas A Boudreau, MD Po Box 1520, Hinesville, GA 31310-8520 Ph: (912) 318-3947 | Douglas A Boudreau, MD 303 Fraser Dr, Hinesville, GA 31313-3712 Ph: (912) 877-2227 |
Dr. Nicole Stack Broerman, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 462 Elma G Miles Pkwy, Hinesville, GA 31313 Phone: 912-369-9400 Fax: 912-877-9438 | |
Kijana Nicola Nix, MD,FAAP Pediatrics Medicare: Medicare Enrolled Practice Location: 455 S Main St Ste 103, Hinesville, GA 31313 Phone: 912-408-6868 Fax: 912-876-6566 | |
Dr. Phillip O Ajayi, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 455 S Main St Ste 101, Hinesville, GA 31313 Phone: 912-876-6868 Fax: 912-876-6566 | |
Mary Judith Allen, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 303 Fraser Dr, Hinesville, GA 31313 Phone: 912-877-2227 Fax: 912-877-2332 | |
Eric Lee Hall, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 512 S Main St Ste A, Hinesville, GA 31313 Phone: 912-369-5437 Fax: 912-369-5740 | |
Mrs. Lisa S Elkin, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 455 S Main St Ste 105, Hinesville, GA 31313 Phone: 912-876-0250 |