NILAPHONE NOK HOMSOMBATH

AUGUSTA, GA
NPI1871805309
Other NameNILAPHONE NOK KETTAVONG
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: GA  007194)
Additional Taxonomies363A00000X Physician Assistant
(Licence: SC  1787)
Enumeration Date2010-07-13
Last Update Date2015-05-29
Business Address
-- NILAPHONE NOK HOMSOMBATH
1350 WALTON WAY EMERGENCY DEPARTMENT
AUGUSTA, GA 30901-2612
Phone number: 706-774-8249
Mailing Address
-- NILAPHONE NOK HOMSOMBATH
380 FROG HOLLOW CT
EVANS, GA 30809-4904
Phone number: 706-832-5046