Individual
JASON MILLER DICARLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-3214
Mailing address
4117 MANSFIELD PL, MARTINEZ, GA 30907-2677
(757) 235-3866
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
RTP001865
GA
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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