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General NPI Number Information
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NPI Number | 1922235076
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Entity Type | Organization
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Legal Business Name | DAY BREAK MEDICAL RESOURCE GROUP
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 4349 WHITE PINE CT
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City | AUGUSTA
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State | GA
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Zip | 30906-8122
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Country | US
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Telephone | 706-267-5931
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Fax |
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Provider Business Mailing Address
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Address Line | 4349 WHITE PINE CT
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City | AUGUSTA
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State | GA
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Zip | 30906-8122
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Country | US
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Telephone | 706-267-5931
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | ALTHEA DAVIS BROWN
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Credential |
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Telephone | 706-267-5931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN059308
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License Number State | GA
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