Individual
DR. JUAQUITO MARIO JORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
818 SAINT SEBASTIAN WAY STE 200, AUGUSTA, GA 30901-2652
(706) 774-8940
Mailing address
818 SAINT SEBASTIAN WAY STE 200, AUGUSTA, GA 30901-2652
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036129844
IL
208600000X
Surgery Physician
Primary
102252
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36129844
—
IL
Enumeration date
06/30/2009
Last updated
01/15/2025
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