Individual
MRS. KAREN A. BOUCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4750 WATERS AVE, SUITE 103, SAVANNAH, GA 31404-6200
(912) 350-8712
(912) 350-8753
Mailing address
4750 WATERS AVE, SUITE 103, SAVANNAH, GA 31404-6200
(912) 350-8712
(912) 350-8753
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005305
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01299269
AMERIGROUP
—
05
—
357708693A
—
GA
Enumeration date
04/28/2008
Last updated
09/10/2010
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