Organization
CSRA WOMENS HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA CRUNK (OFFICE MANAGER)
(706) 922-6903
Entity
Organization
Contact information
Practice address
820 SAINT SEBASTIAN WAY, SUITE 1B, AUGUSTA, GA 30901-2643
(706) 432-0606
(706) 432-0670
Mailing address
820 SAINT SEBASTIAN WAY, SUITE 1B, AUGUSTA, GA 30901-2643
(706) 432-0606
(706) 432-0670
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LCB19990014783
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004402173
—
GA
01
—
GPB033
SOUTH CAROLINA MEDICAID
SC
Enumeration date
03/25/2010
Last updated
01/31/2012
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