Individual
DR. MARYLOU DAVID FERNANDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1113 GARREDD BLVD STE B, AUGUSTA, GA 30909-6757
(706) 364-8220
(706) 922-5856
Mailing address
2467 GOLDEN CAMP RD, AUGUSTA, GA 30906-5515
(706) 790-4440
(706) 790-4393
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
028770
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00344132H
—
GA
Enumeration date
05/10/2006
Last updated
02/22/2021
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