Fanta Elizabeth Kasiah, M.D.
Individual provider Active NPI Family Medicine Physician · Evans, GA
NPI 1639480684 · NPPES record last updated Oct 3, 2014
Key facts
- NPI
- 1639480684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4212 (GA)
- Practice address
- 104 N Belair Rd
Suite 101
Evans, GA 30809-6503 - Phone
- (706) 922-3669
- NPI assigned
- Jun 24, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southland Burke Emergency Medical Services, LLC
Practice addresses (Care Compare)
253 C Robert C Daniel Jr Pkwy
Suite 1
Augusta, GA 30909-0801
Phone (336) 254-1380
351 S Liberty St
Waynesboro, GA 30830-9686
Phone (706) 554-4435
Hospital & facility affiliations
- University McDuffie County Regional Medical Center
- Piedmont Augusta Hospital
- Burke Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130909000461 | GA | Practitioner - Emergency Medicine |
8729227178 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4212 | GA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Med Now Urgent Care, LLC | Family Medicine | Current |
Accepting new patients |
| Au Medical Associates Inc | Current |
Accepting new patients | |
| Acs Primary Care Physicians - Southeast PC | Current |
Accepting new patients | |
| Southland Emergency Medical Services Consolidated, LLC | Family Medicine | Current |
Accepting new patients |
| Southland Burke Emergency Medical Services, LLC | Current |
Accepting new patients | |
| Physicians United Urgent Care | Current |
Accepting new patients | |
| Emanuel County Hospital Authority | Current | Accepting new patients | |
| Peach State Emergency Physicians LLC | Current |
Accepting new patients | |
| Au Medical Associates Inc | Current |
Accepting new patients | |
| Screven County Family Health Center, LLC | Family Medicine | Past | Accepting new patients |
Locations
1350 Walton Way
Augusta, GA 30901
Phone (706) 722-9011
1120 15th St
Augusta, GA 30912
Phone (706) 721-3873
2260 Wrightsboro Rd
Augusta, GA 30904
Phone (706) 481-7000
253 Robert C Daniel Jr Pkwy
Ste 1
Augusta, GA 30909
Phone (336) 254-1380
145 E Peacock St
Cochran, GA 31014
Phone (229) 200-4950
104 N Belair Rd
Ste 101
Evans, GA 30809
Phone (706) 799-5664
931 E Winthrope Ave
Millen, GA 30442
Phone (478) 982-4221
2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792
610 Sparta Rd
Sandersville, GA 31082
Phone (478) 240-2000
117 Kite Rd
Swainsboro, GA 30401
Phone (248) 972-8725
215 Mims Rd
Sylvania, GA 30467
Phone (912) 557-1207
2460 Washington Rd
Thomson, GA 30824
Phone (706) 595-1411
351 S Liberty St
Waynesboro, GA 30830
Phone (706) 554-4435
10901 Stonelake Blvd
Ste 200
Austin, TX 78759
Phone (512) 767-6149
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4212 | GA | Yes |
Addresses
Primary practice location
104 N Belair Rd
Suite 101
Evans, GA 30809-6503
Mailing address
104 N Belair Rd
Suite 101
Evans, GA 30809-6503
Phone (706) 922-3669
Other providers in Evans, GA
- Justen Judge
- Kevin M Kaiser
- Emily Kale
- Kathy B Kallmann
- Clint Karamath Jr.
- Srinivasa Venkata Siva Kumar Kasina
- Teru Kassner
- Katie Nelson, LPC, LLC
- Lakeshia Mae Kauffman
- Poonaminder Kaur
All providers in Evans, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.