Healthcare Provider Details

I. General information

NPI: 1487843744
Provider Name (Legal Business Name): AUGUSTA VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

1 FREEDOM WAY
AUGUSTA GA
30904-6258
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-823-3960
Mailing address:
  • Phone: 706-733-0188
  • Fax: 706-823-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberRN123646
License Number StateGA

VIII. Authorized Official

Name: ROSE GILLENS
Title or Position: NURSE MANAGER
Credential:
Phone: 706-733-0188