Organization
PROSPERITY HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANIQUE LAKEITA ADAMS FNP-BC (FAMILY NURSE PRACTITIONER)
(706) 951-5860
Entity
Organization
Contact information
Practice address
604 BEAUFORT AVE, AUGUSTA, GA 30901-2012
(706) 951-5860
Mailing address
604 BEAUFORT AVE, AUGUSTA, GA 30901-2012
(706) 951-5860
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588091995
—
GA
Enumeration date
07/12/2019
Last updated
07/12/2019
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