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General NPI Number Information
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NPI Number | 1679386809
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Entity Type | Organization
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Legal Business Name | QUEEN CITY ENTERPRISES
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 823 BROAD ST
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City | AUGUSTA
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State | GA
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Zip | 30901-1214
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Country | US
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Telephone | 951-553-3051
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Fax |
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Provider Business Mailing Address
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Address Line | 6163 VERMILION LOOP
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City | GRANITEVILLE
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State | SC
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Zip | 29829-3261
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Country | US
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Telephone | 951-553-3051
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Fax |
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Authorized Official
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Title or Position | HOLISTIC NUTRITIONIST COUNSELOR
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Name | ASET AUGUST
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Credential | CERTIFIED
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Telephone | 951-553-3051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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