Individual
ROBERT PENDERGRAST JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH STREET, AUGUSTA, GA 30912
(706) 721-2191
(706) 721-4920
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2650
(706) 828-6410
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
031096
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000732971A
—
GA
05
—
GT6567
—
SC
Enumeration date
09/22/2006
Last updated
11/30/2012
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