Healthcare Provider Details

I. General information

NPI: 1043377005
Provider Name (Legal Business Name): AUGUSTA ENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 FLUKER ST
THOMSON GA
30824-2108
US

IV. Provider business mailing address

340 N BELAIR RD
EVANS GA
30809-3000
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-5676
  • Fax: 706-722-2824
Mailing address:
  • Phone: 706-868-5676
  • Fax: 706-722-2824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JAMMIE LEE SPARKS
Title or Position: BILLING SUPERVISOR
Credential: CPC
Phone: 706-868-5676