Healthcare Provider Details

I. General information

NPI: 1669389672
Provider Name (Legal Business Name): HALLIE SCAGGS AEMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WATSON BLVD
WARNER ROBINS GA
31093-3432
US

IV. Provider business mailing address

1550 WATSON BLVD
WARNER ROBINS GA
31093-3432
US

V. Phone/Fax

Practice location:
  • Phone: 478-841-1850
  • Fax: 478-478-1005
Mailing address:
  • Phone: 478-841-1850
  • Fax: 478-478-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: