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General NPI Number Information
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NPI Number | 1205988631
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Entity Type | Organization
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Legal Business Name | EAST CENTRAL HEALTH DISTRICT
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2401 CRYSTAL CT
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City | AUGUSTA
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State | GA
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Zip | 30906
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Country | US
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Telephone | 706-790-3485
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 CRYSTAL CT
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City | AUGUSTA
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State | GA
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Zip | 30906-5615
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Country | US
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Telephone | 706-790-3485
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. DAISY LOUISE FERGUSON
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Credential |
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Telephone | 706-667-4282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | LPN039414
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License Number State | GA
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