Provider Demographics
NPI:1922230598
Name:BADY, JAQVETTA DOUGLAS
Entity type:Individual
Prefix:
First Name:JAQVETTA
Middle Name:DOUGLAS
Last Name:BADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 MARKS CHURCH RD STE E
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2472
Mailing Address - Country:US
Mailing Address - Phone:706-733-6615
Mailing Address - Fax:706-733-6615
Practice Address - Street 1:1285 MARKS CHURCH RD STE E
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2472
Practice Address - Country:US
Practice Address - Phone:706-733-6615
Practice Address - Fax:706-733-6616
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA123582171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor