Organization · NPI-2

Augusta Anti-Aging Medicine, LLC

Nurse Practitioner, Family · Evans, GA

NPI number1568047876
StatusActive
Last updated in NPPESMar 17, 2021

Details

NPI
1568047876
Entity type
Organization (NPI-2)
Legal business name
Augusta Anti-Aging Medicine, LLC
Organization subpart
No
Enumeration date
Mar 17, 2021
Certification date
Mar 17, 2021
Last updated
Mar 17, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family––Yes

Other names

  • Augusta Anti-Aging Medicine, LLC (Former Legal Business Name)

Practice location

610 Ponder Place Dr
Evans, GA 30809-3185

Phone 706-707-2808

Mailing address

610 Ponder Place Dr
Evans, GA 30809-3185

Phone 706-707-2808

Other practice locations

605 Medinah Dr
Augusta, GA 30907-9430

Phone 706-707-2808

Authorized official

Samantha S Tojino
Single Member
7067072808

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