Healthcare Provider Details

I. General information

NPI: 1306476296
Provider Name (Legal Business Name): TURRENDER MESHELL BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 EMMETT ST
AUGUSTA GA
30904-5726
US

IV. Provider business mailing address

1313 EMMETT ST
AUGUSTA GA
30904-5726
US

V. Phone/Fax

Practice location:
  • Phone: 706-564-6563
  • Fax:
Mailing address:
  • Phone: 706-564-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: