Individual
KOLYSE WAGSTAFF CAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1210 ROY RD, AUGUSTA, GA 30909-1812
(706) 860-6515
(706) 860-1225
Mailing address
1210 ROY RD, AUGUSTA, GA 30909-1812
(706) 860-6515
(706) 860-1225
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9521
GA
Other
Enumeration date
10/23/2019
Last updated
04/30/2021
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