Healthcare Provider Details

I. General information

NPI: 1952987026
Provider Name (Legal Business Name): DR. TOMEIKA MICHELLE WIMBUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOMEIKA MICHELLE GEORGE

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 HILLCREEK DR
AUGUSTA GA
30909-6484
US

IV. Provider business mailing address

2806 HILLCREEK DR
AUGUSTA GA
30909-6484
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-0200
  • Fax: 706-863-4695
Mailing address:
  • Phone: 706-863-0200
  • Fax: 706-863-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN168615
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: