| Augusta Primary Care Services LLC | |
|
3624 J Dewey Gray Cir Suite 308 Augusta GA 30909-6584 | |
| (706) 855-5650 | |
| (706) 863-0821 |
| Full Name | Augusta Primary Care Services LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 3624 J Dewey Gray Cir, Augusta, Georgia |
| Authorized Official Name and Position | Robert Faile (VICE PRESIDENT) |
| Authorized Official Contact | 8438567923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Augusta Primary Care Services LLC 3624 J Dewey Gray Cir Suite 308 Augusta GA 30909-6584 Ph: (706) 855-5650 | Augusta Primary Care Services LLC 3624 J Dewey Gray Cir Suite 308 Augusta GA 30909-6584 Ph: (706) 855-5650 |
| NPI Number | 1952565210 |
|---|---|
| Provider Enumeration Date | 07/16/2008 |
| Last Update Date | 10/17/2017 |
| Medicare PECOS PAC ID | 2466513874 |
|---|---|
| Medicare Enrollment ID | O20090126000519 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952565210 | NPI | - | NPPES |
| 298706473A | Medicaid | GA | |
| GP5358 | Medicaid | SC | |
| 298706473B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Bhagat K Reddy |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1144225293 PECOS PAC ID: 1850367558 Enrollment ID: I20040903000500 |
| Provider Name | Paul L Coffman |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1437126075 PECOS PAC ID: 0042260796 Enrollment ID: I20050131000252 |
| Provider Name | Sharon Coffield Logan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1861445215 PECOS PAC ID: 4688685894 Enrollment ID: I20060531000078 |
| Provider Name | Sunil K Lal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1952320236 PECOS PAC ID: 5395748297 Enrollment ID: I20060815000173 |
| Provider Name | Bruce Ziran |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1538274592 PECOS PAC ID: 2062404569 Enrollment ID: I20081230000267 |
| Provider Name | Dominic R Gallo |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1891803821 PECOS PAC ID: 3678611019 Enrollment ID: I20091105000215 |
| Provider Name | Chris Charles Carlson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1629062443 PECOS PAC ID: 8426241969 Enrollment ID: I20101018000300 |
| Provider Name | Michael William Blaney |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1992881122 PECOS PAC ID: 7618985110 Enrollment ID: I20101215000928 |
| Provider Name | Mark D Keesling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871871525 PECOS PAC ID: 4183894512 Enrollment ID: I20110823000325 |
| Provider Name | Rachel Milner Mellick |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487935888 PECOS PAC ID: 5496917833 Enrollment ID: I20120502000075 |
| Provider Name | Francisco J Jacome |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1316128432 PECOS PAC ID: 0042464893 Enrollment ID: I20130204000329 |
| Provider Name | Rodolfo Rozindo Machado |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1124235536 PECOS PAC ID: 4587804513 Enrollment ID: I20130715000707 |
| Provider Name | Philip James Kregor |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1598852600 PECOS PAC ID: 2466406301 Enrollment ID: I20140305001745 |
| Provider Name | Christopher S Hogan |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1932220233 PECOS PAC ID: 3779731435 Enrollment ID: I20140325001322 |
| Provider Name | Phyllis P Costello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487081261 PECOS PAC ID: 9638302706 Enrollment ID: I20140428000139 |
| Provider Name | Courtney K Pettiford |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1770700163 PECOS PAC ID: 1850563933 Enrollment ID: I20151207001376 |
| Provider Name | Jacquelyn Kalv |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568848109 PECOS PAC ID: 7911204441 Enrollment ID: I20160329002096 |
| Provider Name | James Bardoner |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1558652032 PECOS PAC ID: 7517259658 Enrollment ID: I20160708002222 |
| Provider Name | Jose Miguel Iturbe |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1174753198 PECOS PAC ID: 2961782198 Enrollment ID: I20161206000540 |
| Provider Name | John Stewart Keeley |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1316164288 PECOS PAC ID: 8527208719 Enrollment ID: I20170214000772 |
| Provider Name | Robert Douglas Rice |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1841461027 PECOS PAC ID: 3274818570 Enrollment ID: I20170329001791 |
| Provider Name | Frederick O'brien |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1629129192 PECOS PAC ID: 4183807985 Enrollment ID: I20170420000285 |
| Provider Name | Jan Carla Pieters Ceyssens |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831608512 PECOS PAC ID: 1153680665 Enrollment ID: I20180108003214 |
| Provider Name | Kimberly Queen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538677679 PECOS PAC ID: 4587910658 Enrollment ID: I20180702003494 |
| Provider Name | Pouyan Arman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679952071 PECOS PAC ID: 7618286063 Enrollment ID: I20180720003053 |
| Provider Name | Jody Christopher Criswell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346893161 PECOS PAC ID: 2769713312 Enrollment ID: I20191011001323 |
| Provider Name | Victoria Aileen Shaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962055590 PECOS PAC ID: 5294168811 Enrollment ID: I20191211002910 |
| Provider Name | William N Kantor |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1851441828 PECOS PAC ID: 6608942495 Enrollment ID: I20200504002517 |
| Provider Name | Phong Jason Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992233407 PECOS PAC ID: 8628342821 Enrollment ID: I20200701000930 |
| Provider Name | Mohammed Almzayyen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013350131 PECOS PAC ID: 9133433840 Enrollment ID: I20200806002152 |
| Provider Name | Douglas T Garrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912511064 PECOS PAC ID: 1658781414 Enrollment ID: I20201105001771 |
| Provider Name | Robert Adam Hardy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770191470 PECOS PAC ID: 3072924638 Enrollment ID: I20201203000376 |
| Provider Name | Melissa Loren Long |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1154917433 PECOS PAC ID: 3072927367 Enrollment ID: I20210127003312 |
| Provider Name | Robert Blackwelder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558993576 PECOS PAC ID: 7911312426 Enrollment ID: I20210216000563 |
| Provider Name | Arthur Robert Johnson |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1730599770 PECOS PAC ID: 0143444984 Enrollment ID: I20211004001770 |
| Provider Name | Justin G Lott |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1326697087 PECOS PAC ID: 9436489754 Enrollment ID: I20211108002725 |
| Provider Name | Faiz Ur Rehman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1518304534 PECOS PAC ID: 5890027882 Enrollment ID: I20211228001990 |
| Provider Name | Vijaykumar Patel |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1922108976 PECOS PAC ID: 0547229197 Enrollment ID: I20220309002198 |
| Provider Name | Daniel Lee Williamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447982475 PECOS PAC ID: 3173909769 Enrollment ID: I20221005001977 |
| Provider Name | Laura Margaret Mcelveen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891428421 PECOS PAC ID: 3072981497 Enrollment ID: I20221116000982 |
| Provider Name | Joshua Hattaway |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1821524802 PECOS PAC ID: 1355712159 Enrollment ID: I20230113000100 |
| Provider Name | Alyssa Imperatore Ziehm |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1134657760 PECOS PAC ID: 2769845445 Enrollment ID: I20230829000436 |
| Provider Name | Dustie Michelle Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477336832 PECOS PAC ID: 8820452014 Enrollment ID: I20230906002355 |
| Provider Name | Desiree Nicole Subyak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285471433 PECOS PAC ID: 0446781611 Enrollment ID: I20240930002614 |
| Provider Name | Russell F Stahl |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1760478242 PECOS PAC ID: 1850300690 Enrollment ID: I20241111000468 |
| Provider Name | Rena Stewart |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1386696391 PECOS PAC ID: 0143227694 Enrollment ID: I20241218000627 |
| Provider Name | Amber Alexis Garrett |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1700624384 PECOS PAC ID: 9739616293 Enrollment ID: I20241220003885 |
| Provider Name | Kendra Batey |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1811488505 PECOS PAC ID: 6406103936 Enrollment ID: I20250613001678 |
| Provider Name | Sudarshana Datta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275096190 PECOS PAC ID: 8921341850 Enrollment ID: I20251103001813 |
| Provider Name | Abhigyan Mukherjee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427581875 PECOS PAC ID: 9335532324 Enrollment ID: I20251104000979 |
Infectious Disease Consultants Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 820 St. Sebastian Way, Suite 4a, Augusta, GA 30901 Phone: 706-724-4376 Fax: 706-731-5289 |
Augusta Hypertention, P.C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1021 15th St Ste 2, Bio Tech Park, Augusta, GA 30901 Phone: 706-722-4688 Fax: 706-722-8194 |
Reba Brown Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 114 Pleasant Home Rd Ste A, Augusta, GA 30907 Phone: 706-364-7398 |
Benjamin L. Rucker M.D. P.C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1138 Druid Park Ave, Suite B, Augusta, GA 30904 Phone: 706-733-9447 Fax: 706-738-0863 |
Neighborhood Improvement Project Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2300 Wrightsboro Rd, Augusta, GA 30904 Phone: 706-790-4440 |
Champion Orthopedics Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1706 Magnolia Way, Augusta, GA 30909 Phone: 706-210-7529 Fax: 706-312-7610 |