Healthcare Provider Details

I. General information

NPI: 1346407814
Provider Name (Legal Business Name): AUGUSTO E SOLTERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 DAWSON RD SUITE 2200
ALBANY GA
31707-2800
US

IV. Provider business mailing address

2336 DAWSON RD SUITE 2200
ALBANY GA
31707-2800
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-8871
  • Fax: 229-312-8743
Mailing address:
  • Phone: 229-312-8871
  • Fax: 229-312-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number17300
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number061350
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME96748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: