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General NPI Number Information
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NPI Number | 1912722190
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Entity Type | Individual
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Provider Name | MRS. ROCQUELLE OLIVIA HENRY
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Gender | Female
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 3942 HARPER FRANKLIN AVE
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-261-5210
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Fax | 706-993-4818
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Provider Business Mailing Address
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Address Line | 2395 TRAVIS PINES DR
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City | AUGUSTA
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State | GA
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Zip | 30906-8924
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Country | US
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Telephone | 706-294-7775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | GA
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