Healthcare Provider Details

I. General information

NPI: 1568384998
Provider Name (Legal Business Name): AUGUSTA UNIVERSITY STUDENT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 SAINT SEBASTIAN WAY # EC1500
AUGUSTA GA
30912-2613
US

IV. Provider business mailing address

987 SAINT SEBASTIAN WAY # EC1500
AUGUSTA GA
30912-2613
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3448
  • Fax:
Mailing address:
  • Phone: 706-721-3448
  • Fax: 706-721-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LACEY OWENS
Title or Position: QUALITY AND COMPLIANCE MANAGER
Credential: MPA
Phone: 706-721-9619