Healthcare Provider Details

I. General information

NPI: 1316031990
Provider Name (Legal Business Name): HEBA LABIB KALDAS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3087 WESTWOOD ROAD
AUGUSTA GA
30909
US

IV. Provider business mailing address

P O BOX 368 114 MAIN STREET
LINCOLNTON GA
30817
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-2093
  • Fax: 706-359-5734
Mailing address:
  • Phone: 706-359-1836
  • Fax: 706-359-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019712
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: