Healthcare Provider Details

I. General information

NPI: 1851651905
Provider Name (Legal Business Name): ALICIA PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 3RD AVE
ALBANY GA
31701-1943
US

IV. Provider business mailing address

727 GILBERT LN
ALBANY GA
31701-5415
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-7900
  • Fax: 229-312-7925
Mailing address:
  • Phone: 229-669-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN178165
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: