Organization
AMAZON SELF DEVELOPMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MYRA SMITH (OWNER)
(706) 432-3600
Entity
Organization
Contact information
Practice address
821 12TH SREET, SUITE B, AUGUSTA, GA 30901-2749
(706) 432-3600
(706) 432-3621
Mailing address
821 12TH SREET, SUITE B, AUGUSTA, GA 30901
(706) 432-3600
(706) 432-3621
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC005104
GA
Other
Enumeration date
01/11/2008
Last updated
01/17/2008
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