| NPI | 1568047876 |
|---|---|
| Former Legal Business Name | AUGUSTA ANTI-AGING MEDICINE, LLC |
| Entity Type | Organization |
| Authorized Contact | SAMANTHA S TOJINO Single Member 706-707-2808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2021-03-17 |