Individual
SUGIARTO TJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
710 CENTER ST, COLUMBUS, GA 31901-1527
(706) 571-1374
(706) 660-2686
Mailing address
PO BOX 1380, COLUMBUS, GA 31902-1307
(706) 571-1374
(706) 660-2686
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0002104
GA
367H00000X
Anesthesiologist Assistant
Primary
2104
GA
Other
Enumeration date
09/01/2005
Last updated
02/22/2023
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