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General NPI Number Information
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NPI Number | 1285151779
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Entity Type | Organization
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Legal Business Name | AUGUSTA ACUPUNCTURE CLINIC, INC
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 4141 COLUMBIA RD STE B
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City | AUGUSTA
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State | GA
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Zip | 30907-5403
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Country | US
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Telephone | 706-888-0707
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Fax | 855-729-9215
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Provider Business Mailing Address
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Address Line | 4141 COLUMBIA RD STE B
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City | AUGUSTA
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State | GA
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Zip | 30907-5403
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Country | US
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Telephone | 706-888-0707
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Fax | 855-729-9215
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Authorized Official
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Title or Position | PRESIDENT/ACUPUNCTURIST
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Name | MR. ERIC SHERRELL
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Credential | LAC
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Telephone | 706-888-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 402
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License Number State | GA
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