Healthcare Provider Details

I. General information

NPI: 1932963071
Provider Name (Legal Business Name): ROBERT LEE WYMBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 INDEPENDENCE DR
AUGUSTA GA
30901-1037
US

IV. Provider business mailing address

PO BOX 12683
AUGUSTA GA
30914-0683
US

V. Phone/Fax

Practice location:
  • Phone: 706-798-1430
  • Fax:
Mailing address:
  • Phone: 706-294-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA000674
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: