Individual
DR. JACOB BOUDREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST # BI2144, AUGUSTA, GA 30912-2426
(706) 910-8827
Mailing address
1120 15TH ST # BI2144, AUGUSTA, GA 30912-0004
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/17/2021
Last updated
08/19/2022
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