ZACHARY THOMAS SELF MD
NPI 1104628635
Student in an Organized Health Care Education/Training Program in Augusta, GA
About Zachary Thomas Self Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ZACHARY THOMAS SELF MD (NPI 1104628635) is an individual student in an organized health care education/training program in Augusta, Georgia, licensed in Georgia (113889) and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Zachary Thomas Self Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
AUGUSTA, GA 30912
AUGUSTA, GA 30912
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Zachary Self's NPI number?
The NPI number for Zachary Self is 1104628635. It was assigned to this individual provider in the NPPES registry on March 25, 2025.
Where is Zachary Self located?
Zachary Self practices at 1120 15th St, Augusta, GA 30912. The listed phone number is (706) 721-4451.
What is Zachary Self's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Zachary Self enrolled in Medicare?
Yes. Zachary Self is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Zachary Self was last updated on June 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Zachary Thomas Self, MD · NPI 1104628635
Student in an Organized Health Care Education/Training Program provider in Augusta, Georgia. Individual provider, active in the CMS NPPES registry since March 25, 2025.
## Identity
- **NPI:** 1104628635 (Entity type: Individual)
- **Enumerated:** March 25, 2025
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **State license:** 113889 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 1120 15TH ST, Augusta, GA 30912-0004
- **Phone:** (706) 721-4451
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** June 18, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1104628635) · Data from the CMS NPPES public registry.