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General NPI Number Information
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NPI Number | 1730383563
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Entity Type | Organization
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Legal Business Name | AGS INC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 164 THOMPSON DR
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1644
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Country | US
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Telephone | 304-842-2273
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Fax | 304-842-2339
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Provider Business Mailing Address
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Address Line | 164 THOMPSON DR
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1644
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Country | US
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Telephone | 304-842-2273
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Fax | 304-842-2339
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GEORGIA DAWN DANIEL
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Credential | CRNP
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Telephone | 304-842-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 29466
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License Number State | WV
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