Healthcare Provider Details

I. General information

NPI: 1568020808
Provider Name (Legal Business Name): LCA AUGUSTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 06/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 CENTRAL AVE
AUGUSTA GA
30904-5734
US

IV. Provider business mailing address

1831 CENTRAL AVE
AUGUSTA GA
30904-5734
US

V. Phone/Fax

Practice location:
  • Phone: 706-739-5822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW CRUMRINE
Title or Position: OWNER
Credential:
Phone: 706-306-4588