Provider Demographics
NPI:1841496528
Name:PROFESSIONAL HEALTH CONTROL OD AUGUSTA INC.
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH CONTROL OD AUGUSTA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PLANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-869-0173
Mailing Address - Street 1:246 BOBBY JONES EXPY STE B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5360
Mailing Address - Country:US
Mailing Address - Phone:706-869-0173
Mailing Address - Fax:706-869-1716
Practice Address - Street 1:246 BOBBY JONES EXPY STE B
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5360
Practice Address - Country:US
Practice Address - Phone:706-869-0173
Practice Address - Fax:706-869-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty