Basic Information
| Provider Information | |||||||||
| NPI: | 1245200203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PILCHER | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 SAINT SEBASTIAN WAY STE 4C | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067745995 | ||||||||
| FaxNumber: | 7067745996 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 SAINT SEBASTIAN WAY STE 4C | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067745995 | ||||||||
| FaxNumber: | 7067745996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 11/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 048515 | GA | N | Other Service Providers | Specialist | 2084N0400X | 48515 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P00905201 | 01 | GA | RAILROAD MEDICARE | OTHER | 000859856C | 05 | GA | MEDICAID | GA1387 | 05 | SC | MEDICAID |