Healthcare Provider Details

I. General information

NPI: 1376483354
Provider Name (Legal Business Name): SENECA NETTLES CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 MOORE RD
AUGUSTA GA
30906-3778
US

IV. Provider business mailing address

1924 MOORE RD
AUGUSTA GA
30906-3778
US

V. Phone/Fax

Practice location:
  • Phone: 678-900-3094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHTC085803
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: