Healthcare Provider Details

I. General information

NPI: 1104942929
Provider Name (Legal Business Name): AUGUSTA NEUROSCIENCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 STEVENS CREEK ROAD
AUGUSTA GA
30907
US

IV. Provider business mailing address

840 STEVENS CREEK ROAD
AUGUSTA GA
30907
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-6957
  • Fax: 706-722-1999
Mailing address:
  • Phone: 706-722-6957
  • Fax: 706-722-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005715
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number059596
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. REGINALD HILL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 706-722-6957