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Individual

PAUL-ROBERT DERENONCOURT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1120 15TH ST, AUGUSTA, GA 30912-1016
(706) 721-8623
Mailing address
1013 WESLEYAN CIR, EVANS, GA 30809-0227
(314) 760-4443

Taxonomy

Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
96592
GA
2085R0202X
Diagnostic Radiology Physician
Primary
96592
GA

Other

Enumeration date
09/20/2019
Last updated
12/12/2024
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