Individual
DR. RENUKA MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MCG 1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-4402
(706) 721-7872
Mailing address
1499 WALTON WAY, SUITE 1400, AUGUSTA, GA 30901-2602
(706) 863-0055
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
01063017
IN
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
049921
GA
2080P0203X
Pediatric Critical Care Medicine Physician
MD.15244R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000927121B
—
GA
05
—
G49921
—
SC
Enumeration date
08/30/2006
Last updated
12/14/2012
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