1033367750 NPI number — AMERICANWORK, LLC

Table of content: (NPI 1033367750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033367750 NPI number — AMERICANWORK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICANWORK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033367750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1727 WRIGHTSBORO RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30904-4049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-638-0350
Provider Business Mailing Address Fax Number:
706-736-8170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1341 DRUID PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904-5723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-364-9037
Provider Business Practice Location Address Fax Number:
706-364-9096
Provider Enumeration Date:
09/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WATERS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
STATE DIRECTOR
Authorized Official Telephone Number:
706-200-8677

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)