Provider Demographics
NPI:1073915450
Name:AU HEALTH PROFESSIONS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:AU HEALTH PROFESSIONS ASSOCIATES, INC.
Other - Org Name:CLINIC FOR PROSTHETIC RESTORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRETLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-721-3285
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:CJ 1101
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-2613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:987 SAINT SEBASTIAN WAY
Practice Address - Street 2:EC 1500
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-2613
Practice Address - Country:US
Practice Address - Phone:706-721-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003180856AMedicaid