Healthcare Provider Details

I. General information

NPI: 1841496528
Provider Name (Legal Business Name): PROFESSIONAL HEALTH CONTROL OD AUGUSTA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 BOBBY JONES EXPY STE B
MARTINEZ GA
30907-5360
US

IV. Provider business mailing address

246 BOBBY JONES EXPY STE B
MARTINEZ GA
30907-5360
US

V. Phone/Fax

Practice location:
  • Phone: 706-869-0173
  • Fax: 706-869-1716
Mailing address:
  • Phone: 706-869-0173
  • Fax: 706-869-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: DONNA R PLANTS
Title or Position: DIRECTOR
Credential:
Phone: 706-869-0173