Healthcare Provider Details

I. General information

NPI: 1578214821
Provider Name (Legal Business Name): AMERICANWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 WINDING WAY APT D
LEESBURG GA
31763-5534
US

IV. Provider business mailing address

1727 WRIGHTSBORO RD STE B
AUGUSTA GA
30904-4049
US

V. Phone/Fax

Practice location:
  • Phone: 229-420-3991
  • Fax:
Mailing address:
  • Phone: 706-736-8170
  • Fax: 706-736-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PATRICK WATERS
Title or Position: STATE DIRECTOR
Credential: LCSW
Phone: 706-200-8677