Individual
NILAPHONE NOK HOMSOMBATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1350 WALTON WAY, EMERGENCY DEPARTMENT, AUGUSTA, GA 30901-2612
(706) 774-8249
Mailing address
380 FROG HOLLOW CT, EVANS, GA 30809-4904
(706) 832-5046
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
007194
GA
363A00000X
Physician Assistant
1787
SC
Other
Enumeration date
07/13/2010
Last updated
05/29/2015
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