Healthcare Provider Details

I. General information

NPI: 1750515672
Provider Name (Legal Business Name): NEIGHBORHOOD IMPROVEMENT PROJECT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 SAINT SEBASTIAN WAY SUITE 404A
AUGUSTA GA
30901-2651
US

IV. Provider business mailing address

2467 GOLDEN CAMP RD
AUGUSTA GA
30906-5515
US

V. Phone/Fax

Practice location:
  • Phone: 706-790-4440
  • Fax:
Mailing address:
  • Phone: 706-790-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number045103
License Number StateGA

VIII. Authorized Official

Name: MRS. MELINDA S RIDER
Title or Position: CEO
Credential:
Phone: 706-790-4440