Individual
IAN C. HERSKOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 SAINT SEBASTIAN WAY STE 4A, AUGUSTA, GA 30901
(706) 774-5995
(706) 774-5996
Mailing address
PO BOX 1705, AUGUSTA, GA 30903-1705
(706) 774-7760
(706) 774-7766
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
34157
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00713292A
—
GA
01
—
110051869
RAILROAD MEDICARE
—
01
—
11D0687551
CLIA NUMBER
—
05
—
G34157
—
SC
Enumeration date
01/24/2007
Last updated
10/23/2018
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