Healthcare Provider Details

I. General information

NPI: 1154668416
Provider Name (Legal Business Name): PREFERRED CHOICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1394 LANEY WALKER BLVD
AUGUSTA GA
30901-2763
US

IV. Provider business mailing address

1394 LANEY WALKER BLVD
AUGUSTA GA
30901-2763
US

V. Phone/Fax

Practice location:
  • Phone: 706-951-8423
  • Fax: 706-737-1127
Mailing address:
  • Phone: 706-951-8423
  • Fax: 706-737-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NATIKA BOTSWANA BROOKS
Title or Position: DIRECTOR
Credential:
Phone: 706-951-8423