| Amazon Self Development, Llc | |
|
821 12th Sreet Suite B Augusta GA 30901-2749 | |
| (706) 432-3600 | |
| (706) 432-3621 |
| Full Name | Amazon Self Development, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 821 12th Sreet, Augusta, Georgia |
| Authorized Official Name and Position | Myra Smith (OWNER) |
| Authorized Official Contact | 7064323600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amazon Self Development, Llc 821 12th Sreet Suite B Augusta GA 30901 Ph: (706) 432-3600 | Amazon Self Development, Llc 821 12th Sreet Suite B Augusta GA 30901-2749 Ph: (706) 432-3600 |
| NPI Number | 1700062437 |
|---|---|
| Provider Enumeration Date | 01/11/2008 |
| Last Update Date | 01/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700062437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC005104 (Georgia) | Primary |
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