Healthcare Provider Details

I. General information

NPI: 1942478128
Provider Name (Legal Business Name): AUGUSTA CENTER FOR OPTIMAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2361 TOBACCO RD
AUGUSTA GA
30906-9220
US

IV. Provider business mailing address

2361 TOBACCO RD
AUGUSTA GA
30906-9220
US

V. Phone/Fax

Practice location:
  • Phone: 706-793-4401
  • Fax: 706-792-0948
Mailing address:
  • Phone: 706-793-4401
  • Fax: 706-792-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number037166
License Number StateGA

VIII. Authorized Official

Name: DR. MARILYN YVONNE CARTER
Title or Position: CEO
Credential: M.D.
Phone: 706-793-4401