Provider Demographics
NPI:1194540658
Name:AUGUST, ASHLEY (CERT HOLISTIC NUTRI)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:AUGUST
Suffix:
Gender:F
Credentials:CERT HOLISTIC NUTRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6163 VERMILION LOOP
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-3261
Mailing Address - Country:US
Mailing Address - Phone:951-553-3051
Mailing Address - Fax:
Practice Address - Street 1:823 BROAD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1214
Practice Address - Country:US
Practice Address - Phone:951-553-3051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
GA171400000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No374U00000XNursing Service Related ProvidersHome Health Aide
No171400000XOther Service ProvidersHealth & Wellness Coach