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General NPI Number Information
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NPI Number | 1275857856
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Entity Type | Organization
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Legal Business Name | CSRA WOMENS HEALTH, LLC
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 820 SAINT SEBASTIAN WAY SUITE 1B
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City | AUGUSTA
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State | GA
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Zip | 30901-2643
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Country | US
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Telephone | 706-432-0606
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Fax | 706-432-0670
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Provider Business Mailing Address
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Address Line | 820 SAINT SEBASTIAN WAY SUITE 1B
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City | AUGUSTA
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State | GA
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Zip | 30901-2643
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Country | US
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Telephone | 706-432-0606
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Fax | 706-432-0670
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA CRUNK
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Credential |
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Telephone | 706-922-6903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | LCB19990014783
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License Number State | GA
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