Individual
TARA K PEDIGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST STE BI1056, AUGUSTA, GA 30912-0004
(706) 721-3813
(706) 721-9286
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
38825
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3894808
—
TN
Enumeration date
09/15/2005
Last updated
11/05/2018
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