Healthcare Provider Details

I. General information

NPI: 1285471433
Provider Name (Legal Business Name): DESIREE NICOLE SUBYAK AGACNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 10/26/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6426
US

IV. Provider business mailing address

3353 OAKRIDGE DR
AUGUSTA GA
30909-2437
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-3232
  • Fax:
Mailing address:
  • Phone: 706-589-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN254588
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: