DR. JACK C BORDERS JR. (NPI# 1306800404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306800404 |
| Entity Type | Individual |
| Full Name | DR. JACK C BORDERS JR. |
| Credential | MD |
| Practice Address |
1120 15th Street Augusta GA 30912-0004 |
| Mailing Address |
1499 Walton Way Suite 1400 Augusta GA 30901-2603 |
| Practice Telephone | 7067246100 |
| Practice Fax Number | 7067246100 |
| Mailing Telephone | 7067246100 |
| Mailing Fax Number | 7067246100 |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2015-11-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
039054 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000617801B | 05 | |
| GA | 000617801F | 05 |
| Street Address |
1120 15TH STREET |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30912-0004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447237375 | Ricardo Azziz | Obstetrics & Gynecology | 1120 15th Street, Augusta, GA 30912-0004 | 2005-12-30 |
| 1174094668 | Mary Gabrielle Helfgott | Advanced Practice Midwife | 1120 15th Street, Ba #7513, Augusta, GA 30912 | 2018-12-10 |
| 1912492471 | Sarah Crumley Asmann | Nurse Practitioner | 1120 15th Street, Department of Surgery, Augusta, GA 30912 | 2018-06-27 |
| 1912499286 | Jillian Marie Soto | Family Medicine | 1120 15th Street, Augusta, GA 30912 | 2018-06-03 |
| 1447740741 | Amanda Meredith Saxon | Nurse Practitioner | 1120 15th Street, Bbr 6518, Augusta, GA 30912 | 2018-05-14 |
| 1447757968 | Mohamed M Meghil | Student in an Organized Health Care Education/Training Program | 1120 15th Street, Gc-1337, Augusta, GA 30912 | 2018-04-11 |
| 1942721667 | Christopher Glen Jackson | Emergency Medicine | 1120 15th Street, Augusta, GA 30912 | 2017-07-03 |
| 1063933000 | Andrea Martinez-velez | Anesthesiology | 1120 15th Street, Augusta, GA 30912 | 2017-06-29 |
| 1063941409 | Viviam Skarleth Trejo | Surgery | 1120 15th Street, Augusta, GA 30912 | 2017-06-08 |
| 1548799976 | Alexander Herzog | Internal Medicine | 1120 15th Street, Augusta, GA 30912 | 2017-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885940 | Hannah Gullickson Folsom | Family Medicine | 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 | 2020-06-11 |
| 1487278909 | Robert Kennedy | Internal Medicine | Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 | 2020-06-01 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1003379280 | Kayla Cox | Internal Medicine | 1120 15th St Bi5070, Augusta, GA 30912 | 2019-04-13 |
| 1619435740 | Justin Ray Mackert | Student in an Organized Health Care Education/Training Program | Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 | 2019-03-07 |
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1487157921 | Julie Ann Matsen | Student in an Organized Health Care Education/Training Program | 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 | 2018-03-12 |
| 1497287031 | Luke Yuung-jier Chang | Ophthalmology | 1120 15th St # Ba2720, Augusta, GA 30912 | 2017-04-02 |
| 1821537622 | Lashawn Kay Boone | Nurse Practitioner | 1445 Harper St, Augusta, GA 30912 | 2017-02-14 |
| 1134675564 | Arnab Saha | Internal Medicine | 1120 15 Th St., Augusta, GA 30912 | 2016-08-26 |
| Find all providers in zip 30912 | ||||
| Taxonomy Code | 207YP0228X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Pediatric Otolaryngology |
| A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942462627 | John Drew Prosser | Otolaryngology | 1120 15th St, Augusta, GA 30912-0004 | 2008-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134380017 | Pediatric Ear, Nose, & Throat of Atlanta, PC | Otolaryngology | 5461 Meridian Mark Road Suite 130, Atlanta, GA 30342 | 2008-06-23 |
| 1578641742 | Amy Owen Reeves | Otolaryngology | 5150 Stilesboro Rd Nw Ste 220, Kennesaw, GA 30152-7742 | 2006-11-02 |
| 1316928823 | James Thomsen | Otolaryngology | 5461 Meridian Marks Rd Ste 130, Atlanta, GA 30342 | 2005-11-10 |
| 1255759494 | Sean Spencer Evans | Otolaryngology | 1001 Johnson Ferry Rd Ne, Atlanta, GA 30322-1900 | 2014-04-04 |
| 1689019580 | Nandini Govil | Otolaryngology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2013-05-06 |
| 1437493467 | Choa Multispecialty, LLC | Otolaryngology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2012-11-15 |
| 1093011249 | Stephanie Ambrose | Otolaryngology | 550 Peachtree St Ne, Suite 1135, Atlanta, GA 30308-2212 | 2011-02-07 |
| 1588896351 | Jonathan Maclean | Otolaryngology | 1365a Clifton Rd Ne, Atlanta, GA 30322-1013 | 2009-08-12 |
| 1619139425 | Kara Kerscher Prickett | Otolaryngology | 2015 Uppergate Dr Ne, Atlanta, GA 30322-0001 | 2008-07-02 |
| 1871760231 | Atlanta Children's Ent, P.C. | Otolaryngology | 3400 Old Milton Pkwy, Suite C-465, Alpharetta, GA 30005-3707 | 2008-05-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.