Provider Demographics
NPI:1407131899
Name:CAMBRIDGE LABS,LLC
Entity Type:Organization
Organization Name:CAMBRIDGE LABS,LLC
Other - Org Name:AUGUSTA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR/COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-821-6880
Mailing Address - Street 1:611 15TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2601
Mailing Address - Country:US
Mailing Address - Phone:706-821-6880
Mailing Address - Fax:706-823-8261
Practice Address - Street 1:611 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2601
Practice Address - Country:US
Practice Address - Phone:706-821-6880
Practice Address - Fax:706-823-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain