Healthcare Provider Details

I. General information

NPI: 1467732701
Provider Name (Legal Business Name): MEDEX ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST STE 10
AUGUSTA GA
30901-2771
US

IV. Provider business mailing address

811 13TH ST SUITE 10
AUGUSTA GA
30901-2700
US

V. Phone/Fax

Practice location:
  • Phone: 706-434-1590
  • Fax: 706-434-1595
Mailing address:
  • Phone: 706-434-1590
  • Fax: 706-434-1595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009766
License Number StateGA

VIII. Authorized Official

Name: HETAL THAKORE
Title or Position: OFFICER
Credential:
Phone: 706-434-1590