MEDICARE: ASHLEY AUGUST CERT. HOLISTIC NUTRI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	374U00000X	Home Health Aide
2	171400000X	Health & Wellness Coach	GA
3	133NN1002X	Nutrition Education Nutritionist	GA

General Provider Information

NPI Number	:	1194540658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY AUGUST CERT. HOLISTIC NUTRI

Provider Business Mailing Address
First Line	:	6163 VERMILION LOOP
Second Line	:
City	:	GRANITEVILLE
State	:	SC
Zip	:	29829-3261
Country	:	US
Telephone Number	:	951-553-3051
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 BROAD ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1214
Country	:	US
Telephone Number	:	951-553-3051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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